According to an article in the American Journal of Roentgenology (AJR), radiologists should consider performing ultrasound first for digital breast tomosynthesis (DBT)-recalled noncalcified masses. 

“Omitting diagnostic mammography when ultrasound is negative has a low false-negative rate,” writes lead researcher Jessica Porembka, MD, an associate professor of radiology at the University of Texas Southwestern Medical Center in Dallas. Noting that ultrasound alone is effective in diagnosing noncalcified masses recalled on screening tomosynthesis, “for asymmetries,” she explains further, “diagnostic mammography may be best without the need for additional ultrasound, while architectural distortions still warrant diagnostic mammography and ultrasound.”

Per the protocol of Porembka and colleagues’ HIPAA-compliant, Institutional Review Board-approved prospective study, 399 women (mean age, 60 years) recalled for noncalcified lesions from screening DBT underwent initial diagnostic ultrasound from July 2017 to June 2019. Imaging decisions—determined via BI-RADS assessments and management recommendations, biopsy outcomes, and follow-up—were recorded using case reports filed on the day of the diagnostic evaluation.

Ultrasound alone without mammography adequately completed the diagnostic evaluation of 71.2% (306/430) of noncalcified lesions recalled from screening tomosynthesis, 93.7% (178/190) of recalled masses, and diagnosed 92.1% (35/38) of cancers, yielding a sensitivity of 94.9% for cancer diagnosis.

“A large number of screening tomosynthesis–detected noncalcified masses may be further evaluated with ultrasound alone, without compromising diagnostic sensitivity,” the authors of the AJR article write.