From Our 2007 Archives

Ultrasound Can Spare Some Women Invasive Breast Biopsy

By Kathleen Doheny
HealthDay Reporter

TUESDAY, June 26 (HealthDay News) -- Using ultrasound to monitor certain breast lesions that have a low probability of becoming cancerous may be a safe and less anxiety-producing alternative to a biopsy, a new study says.

The practice of monitoring certain masses with ultrasound can safely spare women from unnecessary, invasive biopsies, said study author Dr. Oswald Graf, chairman of radiology at the Ambulatory Care Center in Steyr, Austria.

The findings are published in the July issue of Radiology.

Breast ultrasound uses sound waves to make an image of breast tissues. The procedure is less invasive than a biopsy, in which breast tissue samples are taken and analyzed.

The question of whether to follow a suspicious breast tissue area with ultrasound or biopsy is one that radiologists face daily, Graf said. "Shall we perform a biopsy? Then we have a lot of healthy women undergoing an unnecessary biopsy procedure that ultimately yields a benign result. Or shall we follow the lesion with ultrasound? Then we might miss a cancer at an earlier stage," he explained.

Graf's team studied 409 women, average age 48, who had 448 solid masses identified during mammography and ultrasound that were classified as probably benign. Of these 448 masses, 445 were monitored with ultrasound for a range of two to five years, while biopsy was deemed necessary and performed on the other three.

Using ultrasound monitoring for an average of 3.3 years, 442 of the masses remained stable and two grew in size. One woman was diagnosed with breast cancer, the researchers said.

The risk of these masses, originally classified as probably benign, turning malignant during the ultrasound follow-up was very low, about 0.2 percent, Graf said.

The study is the first to show that ultrasound is a safe alternative to biopsy to follow a lesion that has been deemed probably benign by a radiologist, using strict criteria, Graf said.

"But it is essential that lesions strictly meet these criteria," Graf said. The lesion has to be ruled a category 3 under the Breast Imaging Reporting and Data System (BI-RADS). The lesion must also be a solid mass with circumscribed margins and have an oval shape, among other criteria, he added.

Dr. Carol H. Lee, chairwoman of the American College of Radiology's Breast Imaging Commission and professor of diagnostic radiology at Yale University School of Medicine, called the new research "an excellent study."

The study "suggests you don't have to do a biopsy for every tumor you find on ultrasound," she said.

Asked if most radiologists are doing this already, Lee said, "Not necessarily. There are no strict guidelines on what to do, because it depends on how the thing looks," she said.

The take-home message for women: "Women should know that ultrasound follow-up is a reasonable option, based on this study and based on how the mass looks," Lee said.

SOURCES: Oswald Graf, M.D., chairman, radiology, Ambulatory Care Center, Steyr, Austria; Carol H. Lee, M.D., chairman, American College of Radiology's Breast Imaging Commission, and professor, diagnostic radiology, Yale University School of Medicine, New Haven, Conn.; July 2007 Radiology

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