Nonpalpable breast lesions: biopsy methods and patient management

Detection of breast cancer with ultrasound tomography: First results with the Computed Ultrasound Risk Evaluation (CURE) prototype

Although mammography is the gold standard for breast imaging, its limitations result in a high rate of biopsies of benign lesions and a significant false negative rate for women with dense breasts. In response to this imaging performance gap we have been developing a clinical breast imaging methodology based on the principles of ultrasound tomography. The Computed Ultrasound Risk Evaluation (CURE) system has been designed with the clinical goals of whole breast, operator-independent imaging, and differentiation of breast masses. This paper describes the first clinical prototype, summarizes our initial image reconstruction techniques, and presents phantom and preliminary in vivo results. In an initial assessment of its in vivo performance, we have examined 50 women with the CURE prototype and obtained the following results. (1) Tomographic imaging of breast architecture is demonstrated in both CURE modes of reflection and transmission imaging. (2) In-plane spatial resolution of 0.5 mm in reflection and 4 mm in transmission is achieved. (3) Masses > 15 mm in size are routinely detected. (4) Reflection, sound speed, and attenuation imaging of breast masses are demonstrated. These initial results indicate that operator-independent, whole-breast imaging and the detection of breast masses are feasible. Future studies will focus on improved detection and differentiation of masses in support of our long-term goal of increasing the specificity of breast exams, thereby reducing the number of biopsies of benign masses.

Effect of Referring Physician Specialty and Practice Type on Referral for Image-Guided Breast Biopsy

PURPOSE

To determine whether referring physician specialty and practice type affect the likelihood of referral for image-guided breast biopsy.

METHOD

We reviewed the records of every patient who received a Breast Imaging Reporting and Data System (BI-RADS) category 4 or 5 examination (mammography, ultrasound, or both) performed during the year 2000 at both our community- and hospital-based practices. We recorded the referring physician specialty and office location (academic medical center vs. community), breast-imaging facility location (hospital vs. community), patient age, patient insurance status, BI-RADS category, and palpability of the lesion. Multiple logistic regression analysis was performed to examine the relationship of these factors to the biopsy type (surgical vs. image-guided).

RESULTS

Of the 831 patients with a BI-RADS Category 4 or 5 report, 734 underwent follow-up surgical or image-guided needle biopsy. Multiple logistic regression analysis demonstrated that referral by a nonsurgeon or by a physician at the academic medical center was associated with a higher likelihood of the patient's being referred for image-guided biopsy. Patients referred by surgeons and community physicians were more likely to undergo surgical biopsy. BI-RADS Category 5 examinations and palpable lesions were also associated with a higher probability of undergoing surgical biopsy. Patient age, insurance status, and breast-imaging facility location were not related to biopsy type.

CONCLUSIONS

In our practice, patients referred for breast imaging by nonsurgeons and academic physicians were more likely to be referred for image-guided biopsy, whereas patients referred by surgeons and community physicians were more likely to undergo surgical biopsy.