From the July 2016 issue of HealthCare Business News magazine
The only change in variable in the ultrasound evaluation was the addition of SWE to complement the evaluation. It is important to note that the percentage of positive ultrasound biopsies with negative mammograms would be higher if those biopsies performed for fibroadenomas were removed. The American College of Radiology (ACR) recommends against the biopsy of benign lesions, but many women want confirmation that a lesion is in fact benign. As a physician, it is just as important to be able to reduce the stress levels of patients and ensure the peace of mind that only a biopsy can provide.
In addition, the ability to downgrade a lesion through the use of SWE as well as upgrade when necessary provides an increased level of confidence to the radiologist. A prospective multicenter study of 958 women confirmed that adding SWE improved specificity of ultrasound mass assessment without loss of sensitivity2. The data from our breast center suggests similar results. The addition of SWE has resulted in an increase in cancers detected, a reduction in unnecessary biopsies, the ability to upgrade and downgrade lesions and an increase in overall diagnostic confidence for the breast radiologist.
Patient outcomes
In addition to the clinical impact of SWE, there are notable benefits to the patient. The finding of cancers that may have otherwise gone undetected is a clear benefit, but several others are also important to note. The reduction in stress for the patient cannot be overstated. For the patient who is able to avoid an unnecessary biopsy, the anxiety of having to go through the procedure is circumvented. For those that do require a biopsy, the ability to quickly identify the need for the biopsy, as well as conduct the biopsy efficiently, results in a less stressful situation for the patient.
SWE is a technological advance that has breathed new life into a trusted modality within the breast center — ultrasound. The additional information that SWE provides the radiologist allows for an improved level of diagnostic confidence, a reduction in unnecessary biopsies, fewer false positives and false negatives. For the patient, the reduction in stress and anxiety is profound. Unfortunately, though, education and adoption remain as the two major challenges to date. SWE does continue to be a benefit to the breast center, and as clinical use increases, so too will the inevitable benefits to clinician, patient and staff.
About the author: Kamilia Kozlowski is a board-certified diagnostic radiologist. She attended the University of Rhode Island, and earned her B.S. from Simmons College in Boston. She received her Doctor of Medicine from Wayne State University Medical School in Detroit. When Dr. Kozlowski relocated to Knoxville, Tennessee, in 1983, she started the Knoxville Breast Center. Practicing as a clinical breast radiologist, she has paved the way to developing a more efficient delivery of breast health care.
