Breast ultrasound in breast cancer surveillance;
incremental cancers found at what cost?
by Dr. Luke Bromley, Dr. Jennifer Xu, Mr. Su-Wen Loh, Dr.
Grace Chew, Eddie Lau, Dr. Belinda Yeo
The Breast: VOLUME 54, P272-277, DECEMBER
01, 2020
Highlights
• Breast ultrasound in asymptomatic surveillance after
breast cancer surgery was found to have a sensitivity of 44.1%.
• Breast ultrasound detected 7 recurrences in 390 patients
who did not meet criteria for adjunct breast US and had normal mammography
• Breast ultrasound generated 26 additional biopsies per
1000 US compared to mammography in surveillance, creating considerablecosts.
• Cancer detection by breast US alone did not lead to
statistically significant survival benefit over mammography.
Abstract
Purpose
To determine the diagnostic parameters of breast ultrasound
(US) in the setting of routine radiological surveillance after a diagnosis of
breast cancer and evaluate costs of the inclusion of breast US as well as any
survival benefit of US detected cases of recurrence in surveillance.
Methods
622 patients underwent breast cancer surgery and follow up
at Austin Health from July 2009 to December 2015. Retrospective data analysis
was performed to determine; diagnostic parameters, financial costs of US and
survival outcomes of US detected cases of recurrence.
Results
Patients underwent 1–9 years of breast cancer surveillance,
with a median of 4.24 years. 390 (62.7%) patients underwent additional breast
US surveillance to mammography. 232 (38.3%) fit criteria for use of additional
breast US. 199 abnormal imaging episodes occurred, leading to 16 screen detected-cases
of locoregional recurrence. US alone generated 107 abnormal images and found 9
cancers. US had a sensitivity of 44.1%, specificity of 95.2% and positive
predictive value of 11.7% in comparison to mammography; 20.6%, 97.4% and 9.9%
respectively. US had a biopsy rate of 4.0% and lead to an incremental cancer
detection rate of 0.38%. The cost of incremental cancer found was $31,463.72
AUD. Survival outcomes based on method of detection of recurrence were
insignificant (p value = 0.71).
Conclusions
Breast US has a sensitivity of 44.1% and detected seven
recurrences that were mammographically occult. Breast US has a similar PPV to
mammography in surveillance. Breast US generated considerable biopsy rates and
costs. Survival analysis was not able to detect any benefit of US detected
cases of recurrence.
