U S performance mixed in breast cancer survivors.

By Kate Madden Yee, AuntMinnie.com staff writer.

February 27, 2020 -- Supplemental screening ultrasound shows a mixed performance in women with a personal history of breast cancer, with lower sensitivity and a higher interval cancer rate. But the modality also had higher specificity, according to a study published online February 25 in Radiology

The findings suggest that the quest for effective ways to follow breast cancer survivors continues, wrote a team led by Dr. Soo-Yeon Kim, PhD, of Seoul National University Hospital in South Korea.

"Further research is needed to more accurately identify women who will benefit from supplemental ultrasound screening," the group wrote.

Breast cancer survivors are more vulnerable to developing second cancers, and they are tracked carefully with regular imaging. But mammography has shown lower sensitivity and higher interval cancer rates in women with a history of the disease compared with those without, Kim and colleagues noted.

Breast MRI is recommended for screening women at high risk of breast cancer, but it has its downsides, including high cost and the need for a contrast agent. Because screening breast ultrasound is readily available, doesn't require contrast, and is cost-effective, interest in using it to track breast cancer survivors has increased.

Kim and colleagues compared the performance of screening breast ultrasound between women with and without personal history of breast cancer. Their study included 3,226 breast cancer survivors and 3,226 women without history of the disease, all of whom underwent supplemental breast ultrasound and mammography between January and December 2013. The women were matched by age and breast density.

Fourteen cancers were identified among the breast cancer survivors (six on screening, eight interval) and 13 among the women with no personal history of the disease (12 on screening, one interval). Supplemental ultrasound's performance among the two groups of women varied.

Performance of supplemental screening ultrasound
Performance measure	Women with no personal history of breast cancer	Breast cancer survivors	p-value
Abnormal interpretation rate	11%	7.3%	< 0.001
Biopsy rate	1.8%	1.2%	0.04
Interval cancer rate per 1,000 women	0.3	2.5	0.02
Sensitivity	92%	43%	0.03
Specificity	89.3%	92.8%	< 0.001

"The low sensitivity and high interval cancer rate in women with a personal history of breast cancer imply that limited sensitivity of mammography in these women might have not been fully overcome by supplemental ultrasound," Kim and colleagues wrote. But, "regarding false-positive findings, supplemental ultrasound in women with a personal history of breast cancer showed lower abnormal interpretation rates, lower biopsy rates, and higher specificity than in women without a personal history of breast cancer."

It's clear that more research is necessary to determine how best to track breast cancer survivors, wrote Drs. Christoph Lee and Janie Lee, both of the University of Washington in Seattle, in an accompanying editorial.

"Additional studies are needed in larger and more diverse settings to better define the benefits and harms of supplemental screening among women with a previous history of breast cancer," they wrote.

Which US method is best for DVT.

By  Theresa Pablos, AuntMinnie Staff writer

February 17, 2020 -- Three different compression ultrasound methods all performed well for imaging deep vein thrombosis (DVT) in a study published online on February 11 by PLOS One. The failure rates for single limited, serial limited, and whole-leg ultrasound ranged from 1% to 2%.

While the three methods are regularly used in clinical practice to help identify DVT, there is no consensus about which one works best. The authors reviewed dozens of studies with thousands of patients and found that no one ultrasound method stood above the rest.

"In the present meta-analysis, more recent studies using clinical follow-up as the reference method showed very comparable failure rates of the three strategies," wrote the authors, led by Dr. Noémie Kraaijpoel from the department of vascular medicine at the University of Amsterdam. "This could imply that there may not be a preferred strategy when taking only safety into account."

The authors searched the scientific literature for compression ultrasound studies from on January 1, 1989, the year the first high-quality research on the modality was published, through July 2019. They included studies using three methods of imaging adults with suspected DVT:

1. Single limited compression ultrasound -- a single examination of the proximal deep veins
2. Serial limited compression ultrasound -- two examinations about five to 10 days apart of proximal deep veins
3. Whole-leg compression ultrasound -- a single examination of both distal and proximal deep veins

Six studies with 2,079 patients assessed single limited compression ultrasound. The analysis showed the modality had a 1.4% failure rate and 6.4% proportion of positive results, although the findings varied among the included individual studies.

For serial limited compression ultrasound, the authors included 11 studies with 3,360 patients. The modality had a 1.9% failure rate and 25% proportion of positive results.

Finally, seven studies with 3,159 evaluated whole-leg compression ultrasound. The findings showed a failure rate of 1% and 25% proportion of positive results.

While all included studies had comparable failure rates (p = 0.36), the proportion of confirmed DVT was significantly higher for serial limited and whole-leg compression ultrasound than for single limited compression ultrasound. The authors noted the difference in prevalence could be the result of patient selection.

Notably, single limited compression ultrasound had a lower DVT prevalence -- likely due to the selection of patients with a lower DVT risk. As a result, the modality could theoretically have a higher failure rate if more DVTs had been found in the group.

Nevertheless, the compression ultrasound methods produced similar results and may be considered equivalent for clinical practice.

"The failure rates of single limited, serial limited, and whole-leg [compression ultrasound] for DVT were found to be quite comparable in patients selected as per the individual study diagnostic algorithms," the authors wrote. "Preference for one of the strategies should be based on probability assessment, feasibility, and expertise."