Purpose: At Assuta Medical Centers Network, dedicated breast technologists who underwent a structured training program perform breast ultrasound (US). In order to provide good service to the patients, the technologist may decide to perform US adjunct to screening mammography during the same visit. The current indications for screening breast US as adjunct to mammography include high risk patients with dense breast. Since we had the impression that the volume of the adjunct US was too high we sought to investigate the indications for US performed, and whether these US exams had changed patient management and
outcome.
Materials & Methods: We reviewed files of all patients who underwent screening mammography and adjunct US during the visit by a trained breast imaging technologist and based upon the technologist’s decision during Nov-Dec, 2010. Demographics including patient age, family and personal history of breast and ovarian cancer, as well as other cancers, personal history of fertility treatments, doctor’s referral letter, breast density. Based on these, indications for US were categorized as follows: indicated (high risk+dense breast), a lesion identified in prior screening exams, a known benign lesion from a prior screening, doctor’s referral, dense
breast, family history of either breast or ovarian cancer (high risk) and technologist’s judgment. Indicated US + lesion in current mammography were considered as justified. Justified and unjustified USs were correlated with final BIRADS and biopsies.
Results: 94 patients (age range 37-78, mean 55 years) performed same day screening mammography and US at a single site. Thirteen patients (14%) had a indicated US (high risk+dense breast), a lesion identified in current mammography (9), a known benign lesion from a prior screening (12), doctor’s referral (13), dense breast (14), family history high risk (20), and technologist’s judgment (13). There were 22 justified US and 72 unjustified. In this study group there was only 1 biopsy, in a patient that had a family history of breast cancer, non-dense breast and a lesion in the current mammography which was benign. Non of the unjustified US had changed the management or outcome. One justified US changes the management but not the outcome.
Conclusion: Same day US based on a technologist judgment can significantly raise the workload without a positive impact on management or outcome. Unjustified doctor’s referrals and misjudgment of the technologists were the predominant contributing factors.
