Clinical Breast Exam + US – More Accurate than Mammogram

physical breast exam and ultrasound

When a woman or clinician feels or sees an unusual change in the breast, the woman is typically referred for a mammogram (conventional or 3-D) also referred to as a digital breast tomosynthesis (DBT) scan.

It is expected that the radiologist who views the mammogram scans will be able to identify the location of the palpable lump in order to reject it as being a benign observation, or something that requires further investigation. 

Unfortunately, mammograms can miss a substantial portion of breast cancers that are present.1

Automated breast ultrasound (ABUS) and/or magnetic resonance (MRI) may be used following a mammogram to determine if a biopsy is required. 

Stand-Alone Mammogram Less Accurate than Physical Breast Exam with Targeted Ultrasound

Recent evidence from high income national health care programs finds that a physical exam is essential for early diagnoses.2 The latest evidence comes from Holland. Dr. Linda Appleman’s team investigated what happens when a lump is immediately followed up by targeted ultrasound rather than a mammogram.3

From September 2017 to June 2019, 1,961 women in Holland reported feeling a lump and enrolled into Appleman’s study. Each woman received a targeted ultrasound (US) to determine if the lump she felt was a harmless water-filled cyst or a solid tumor that required biopsy. With ultrasound (US) as the primary imaging tool, 81% of women received normal (benign) results, and 10% of women received confirmation of a malignant tumor (US sensitivity, 98.5% [95% CI: 96, 100]; US specificity, 90.8% [95% CI: 89, 92]). DBT was used after an ultrasound reported negative lump finds to validate ultrasound’s accuracy in order to determine if US could be used as a stand-alone breast imaging modality for assessing lump finds from a physical breast exam.

Dr. Appleman concluded that “[ultrasound] was accurate as a stand-alone breast imaging modality in the assessment of focal breast complaints.”

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