Ultrasound-first strategy for noncalcified lesions in DBT proves cost-effective
Recent research highlights the cost-effectiveness of an ultrasound-first strategy for evaluating noncalcified lesions recalled from digital breast tomosynthesis (DBT) screenings.[1] This approach also saves patients a lot of time by avoiding extra appointments, explained Jessica H. Porembka, MD, of the breast imaging division at University of Texas Southwestern Medical Center in Dallas. Porembka, one of the study's authors, spoke with Radiology Business in an video interview at the Radiological Society of North America (RSNA) 2024 meeting in December.
"What we found was that ultrasound-first, with or without diagnostic mammography, is more cost effective than doing diagnostic mammography first, which has been the traditional strategy," Porembka explained.
The study found 71.2%, or 306 out of 430, of noncalcified lesions recalled from screening DBT were considered to have undergone adequate workup by ultrasound alone. She said ultrasound alone was able to assign a final BI-RADS category assessment from 1 to 5. This resulted in an approximate cost savings of $680 over the course of the study. When tested across multiple scenarios, ultrasound-first was the most cost-effective strategy in 93% of iterations. While the shift does not necessarily reduce the number of biopsies performed, it has likely contributed to a decrease in annual diagnostic mammograms and potentially a slight reduction in stereotactic biopsies.
Beyond cost, efficiency improvements were also seen, Porembka said. Patients who could be effectively diagnosed via ultrasound alone avoided unnecessary mammograms, reducing scheduling burdens and improving overall patient experience. Though the study did not directly measure time savings, it is likely that the ultrasound-first approach streamlines the diagnostic process, providing added convenience for patients and radiologists alike.
Ultrasound was particularly effective for assessing masses, with 93% of cases successfully evaluated without additional imaging. However, architectural distortions and asymmetries were best assessed with diagnostic mammography first, with only 53% being fully evaluated via ultrasound alone.
Implementation of breast ultrasound-first approach
At Parkland Radiology and UT Southwestern, the approach has been adapted in practice. All patients with masses undergo ultrasound first, while cases involving asymmetries or architectural distortions begin with diagnostic mammography. The institution relies on experienced sonographers and radiologists to ensure high-quality imaging and diagnostic accuracy without the use of automated breast ultrasound systems (ABUS).
Porembka emphasized that while cost savings from the study may appear modest, the broader impact across healthcare systems could be significant. But more importantly, she said the study reinforces the value of optimizing diagnostic pathways to improve efficiency, reduce unnecessary procedures and enhance patient satisfaction.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com