A      Evidence based guidelines - the evidence base for ultrasound examination of women with suspected malignancy

Evidence Table J8 - US

Ultrasound examination of women with a clinical suspicion of cancer

A

  

Clinical Problem

Clinical suspicion of cancer - ultrasound

A1

  

Ref No. in MBUR4 (if any)

J8

A2

  

Section in MBUR4

Breast disease

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Search strategy: databases used; period; MeSH headings; other key words.

Medline: breast disease/breast neoplasm/fibrocystic disease of breast 82323; Ultrasonography 16757; English language, 1985-2000; result = 161; 55 reviewed. Embase: explode ‘breast disease’ all subheadings 80712; ultras* or sono* LA=English & 1985-2000 27118; result = 568; 142 reviewed.

C

  

Search results: no. found;

no. used.

Medline 22; 1 used Embase 38; 3 used

D

  

Reference numbers of cited references in attached master list.

J8 12; J8 13; J8 14; J8 15.

E

  

Summarised results from each of the cited references

All references show a greater sensitivity & specificity for ultrasound in the detection & classification of palpable breast masses and recommend its increased use as an adjunct to mammography in this clinical setting particularly in the x-ray dense breast or when the mammogram is negative in the presence of a clinical abnormality

F

  

Statement (= the conclusion drawn from E)

Not indicated in breast screening. Ultrasound recommended as an adjunct to mammography

G

  

Evidence level of F classified I - IV

2

H

  

Investigation

Ultrasound

I

  

Recommendation *

1 Indicated

J

  

Grade of Recommendation

A - C

B

K

  

Comment (if any) to go in booklet version of MBUR5

 Performed in the context of triple assessment at a specialist breast clinic (clinical examination, mammography/ultrasound & cytology/core biopsy)

L

  

Any other comments on this problem (e.g. caveats; suggestions for research or systematic review; cost or opportunity cost; users' views.

Carolyn Cordiner, Caroline Rubin and Mary Briley

Comments: Greater accuracy attributed to ability to diagnose lesions in x-ray dense breasts. Combination of mammo & ultrasound demonstrates 99% of palpable cancers

References: -

Ref ID Author; Year; Country; Grade (I-IV). Aims Patient population Study design* Results
J8 12 Smallwood J A, 1986, GB, IIb Accuracy of breast ultrasound compared with mammography 1000, US
142, Mammo		 Retrospective Prospective Sensitivity 93%/82%; Specificity 95%/89%. Sensitivity 91%/81%; Specificity 81%/69%.
J8 13 Georgian-Smith D, 2000, IIb Determine the rate of sonographically occult malignancy in women with palpable breast abnormalities 1,346 masses 616 palpable Retrospective Sonography detected all palpable malignant lesions (18 were mammographically occult)
J8 14 Durfee S M, 2000, IIb To determine the utility of sonography in the evaluation of palpable breast cancers invisible on mammography 298 cancers Retrospective 38 not seen on mammo; 32 of these were visible of ultrasound
J8 15 Khattar S C, 1995, Ib To assess the value of ultrasound in detecting focal lesions, differentiating benign from malignant, detecting axillary dissemination of malignant disease & assessing the clinical impact of breast ultrasound in symptomatic women. 199 Prospective, consecutive, blinded 28 cancers; 27 detected with ultrasound, 22 with mammography; p=0.037
* e.g. RCT Comparison (pro/retro-spective)
Series (pro/retro-spective)
Audit