Sonography vs mammography: The jury is still out
Although studies comparing screening methods have not been performed in the United States, a small Taiwanese study directly compared ultrasound to mammography in 105 women without breast implants. This retrospective cohort study found sonography to be a more useful diagnostic tool than mammography in Taiwanese women.5 Sonography had the highest sensitivity (87.5%) compared to physical examination (50.0%) and mammography (25.5%).
Sonography was recommended as the imaging tool for Asian women with smaller, denser breasts. However, it is unclear whether this result applies to US women or women who have undergone breast augmentation surgery.
Training in implant imaging is needed
Mammography appears to be the most effective screening method for women with breast implants. Despite the small differences in cancer characteristics at diagnosis between augmented and nonaugmented women, overall prognosis and survival rates are no different.1-3,6 This is true whether a screening mammogram or diagnostic mammogram is used. In any case, all available findings suggest that clinicians who perform mammography should be trained in imaging the augmented breast.6-8
Recommendations
The National Cancer Institute indicates that the best screening method for augmented women is mammography performed at a facility with employees trained in implant imaging.7 The American College of Radiology’s practice guidelines affirm that mammography is the best imaging tool available.8 The American College of Obstetrics and Gynecology and the US Preventive Services Task Force don’t comment on screening augmented women.
Acknowledgments
The opinions and assertions contained herein are the private views of the author and not to be construed as official, or as reflecting the views of the US Air Force Medical Service or the US Air Force at large.