Screening and diagnostic use of breast ultrasound in young women

Background: Breast ultrasound is usually the first imaging modality that is offered to women aged less than 40 years. The efficacy of preventive use has been questionable due to low incidence and technical limits of the modality. However in clinical practice ultrasound keeps its important role especially in the diagnostic setting. The aim of this study is to determine the role of ultrasound as preventive and diagnostic imaging modality in women aged 40 years and younger.

Material and Methods: We analyzed workload data from a center specializing in breast cancer screening and diagnostics obtained in the period from January 1st 2013 to December 31st 2014. We studied the numbers of patients and examinations, proportion of symptomatic patients and correlated them with the results of examinations, numbers of indicated biopsies and histology.

Results: Within the period of 2 years 10972 ultrasonography examinations were performed in women aged 40 years and less (age range from 17–40 years). 7647 (69,7%) examinations were for preventive reasons, 3325 (30,3%) of women were symptomatic (reported a palpable lump, nipple discharge or skin or nipple changes). 2967 (89,2%) of symptomatic women had no lesion visible in ultrasound or lesions with benign appearance (such as cysts) were found. In the studied population 358 lesions were found suspicious and indicated for core needle biopsy. 253 (70,7%) of biopsies were performed on symptomatic lesions, 105 (29,3%) lesions were not palpable. We revealed total 70 carcinomas, only 5 (7,1%) of those were not palpable and were found incidentally (detection rate 0,6/1000 in asymptomatic women). The detection rate of breast cancer in the symptomatic group of patients was 19,5/1000 and malignancy represented 19,5% of lesions indicated for biopsy. Additionally total 288 benign findings were found and indicated for biopsy (80,6% of all lesions found), 188 (65,3% of benign lesions)were clinically manifest, additional 100 (34,7%) benign lesions were incidental findings in ultrasound.

Conclusions: Breast ultrasound reaches low effectiveness in preventive setting in women younger than 40 years. Most of the cancers in this age are clinically manifest at the time of diagnosis and incidental finding of a malignant lesion in an asymptomatic patient is rare. However ultrasonography represents an important decision making tool in patients with clinical symptoms. In a patient with clinical symptoms the probability of malignancy is much higher, especially if a lesion is found by ultrasound.

No conflict of interest.