ACRIN study supports ultrasound paired with mammography

Dan Anderson

Twelve-year-old Scotch with a fine Cohiba; warm apple pie with vanilla bean ice cream; mammography with ultrasound: All of them are good on their own, but they're better when served up together.

The last combination was proven by the American College of Radiology Imaging Network (ACRIN) to be more effective in the diagnosis of breast cancer in high-risk patients than mammography alone. ACRIN's results, which were previewed last fall, were published last month in the Journal of the American Medical Association. They showed the addition of ultrasound detected 28% more cancers in a study group of more than 2,800 women. The study focused on higher-risk women, such as those with denser breast tissue.

Mammography alone detected 50% of cancers in the women, but adding ultrasound sent that rate soaring to 78%.

Of course, everything has a downside. My general practitioner would quibble with my cigars and Scotch, and probably with the sweets, too. And in the ACRIN study, researchers also discovered a greater chance of coming up with false positives. The result of that was 40 women in the study had to undergo unnecessary biopsy.

"The study results confirm that screening ultrasound in combination with mammography detects more cancers than mammography alone in women at increased risk for breast cancer," said Wendie Berg, MD, PhD, a radiologist with American Radiology Services at Johns Hopkins Green Spring, Lutherville, Md. "However, this benefit comes with the added risk of a false-positive result. If we are going to offer screening ultrasound, we need to inform women of the substantial risk of receiving an unnecessary biopsy."

Jeffrey Blume, associate professor and deputy director of the ACRIN Biostatistics and Data Management Center at Brown University, told ScienceDaily: "The medical community may well decide that the screening benefit is offset by the increase in risk to women from a false-positive finding. However, this study also shows that supplemental ultrasound may be beneficial in women at high risk of breast cancer who could not, or would not, otherwise undergo a magnetic resonance imaging scan."

Berg notes that the cancers that were detected with ultrasound were typically small, invasive cancers that had not yet spread to the lymph nodes. "These are types of cancers that we most need to be finding," she told Reuters.

Indeed they are, and that's precisely why ultrasound should supplement mammography. Next will be the inevitable fight with payors. This is a no-brainer. The government and private insurers should work together with the medical community to support the secondary analysis using ultrasound. They're better together.

We welcome two new members to the editorial advisory board this month:

Steven Renard is an industry consultant with 15 years' experience in the area of imaging and radiology. He previously was president and CEO of Liberty Pacific Medical Imaging, an outpatient operator. He's a member of the RBMA, and has advised major manufacturers.

Michael Schaff is a health care attorney who appeared on our December 2007 cover. He has a broad background in the health arena and has written extensively in the legal community. He is on the board of advisors of the Radiology Administrator's Compliance and Reimbursement Insider and is a frequent lecturer.

Dan Anderson
Editorial Director