Breast Density Changes the Breast-imaging Landscape

Cristen Bolan, MS


Appl Radiol. 2013;42(3):20-25. 

In This Article

Automated Ultrasound

Currently, there is only one ultrasound system approved in the United States for breast cancer screening as an adjunct to mammography for asymptomatic women with > 50% dense breast tissue and no prior breast interventions. This system, the somo•v® Automated Breast Ultrasound (ABUS) (recently acquired by GE Healthcare) has made significant improvements in the visualization of cancer-hiding tissue in dense breasts.

"Mammography is an effective tool at finding breast cancer, but it doesn't work equally well in everyone," noted Rachel F. Brem, MD, Director, Breast Imaging and Interventional Center, Professor of Radiology, Vice Chair, Research and Faculty Development, The George Washington University Medical Center, Washington, DC. Dr. Brem was the principal investigator of the SOMO-INSIGHT clinical study examining whether full-field digital mammography along with the somo•v could improve breast cancer detection when compared to mammography alone in women with dense breasts.

"In recently completed studies demonstrated with the addition of somo•v ABUS, we find about 30% more cancers in women who have a normal mammogram, normal physical examination, and dense breasts. For the > 40% of women who have dense breasts, this is a significant advancement in their breast healthcare," said Dr. Brem.

She added, "What ABUS does is solves the problem of how to find cancer in dense breasts and at an earlier stage."

As new breast-density legislation is adopted nationwide, increasing numbers of women with dense breasts will require ultrasound screenings in addition to mammography. The challenge in the clinical setting is how to streamline the process. The standard procedure today is to use hand held ultrasound, which is very operator dependent. Comparatively, automated breast ultrasound systems lend themselves better to the screening environment, according to Dr. Brem.

With somo•v ABUS, the scanner is positioned on the breast and the technologist presses a button to begin a 3-dimensional (3D) ultrasound scan of the front, outer, and inner sides of the breast. Siemens Healthcare also offers an automated ultrasound, the ACUSON S2000•Automated Breast Volume Scanner (ABVS).

In a new study, Marcela Böhm-Vélez, MD, of Weinstein Imaging Associates in Pittsburgh, PA, and Ellen B. Mendelson, MD, a Diagnostic Radiologist at Northwestern Memorial Hospital, Chicago, IL, are using the ABVS for screening and comparing hand held with automated breast ultrasound. The design of the study is to show that they can detect as many lesions with the ABVS system as with hand held ultrasound.

"With 40% to 50% of the population with dense breasts, there are not enough trained sonographers available to do breast ultrasound for all of these women. That is why hand held ultrasound would be a good option for screening all of these women with dense breasts without requiring a technologist there doing it," said Böhm-Vélez. "We hope that this technology could replace hand held ultrasound, especially for the screening patient."

Another important feature with ABVS is the additional coronal view. "The ABVS technology provides the coronal view, which we can't view with hand held ultrasound, and the coronal view better shows the pulling of the Cooper's ligaments, which is an indirect sign that there may be a cancer there," said Böhm-Vélez. "Since you have 3D reconstruction, you can look at images from any view—coronal, transverse, longitudinal, whatever you want—instead of looking at 2D static images with the hand held ultrasound."

She added, "I think for a large screening program, there is a role for this technology, especially for women with dense breasts."