Ultrasound-based, teleradiology-backed breast cancer screening program holds promise

An ultrasound-based, teleradiology-backed breast cancer program holds promise in expanding access to screening across low-resource settings, according to new research published Wednesday. 

China has faced barriers to implementing traditional mammography surveillance, due to its dispersed population, insufficient equipment and funding obstacles. Medical providers there have deployed automated breast ultrasound as an alternative, with the technology less expensive and more ubiquitous, researchers detailed in the American Journal of Roentgenology [1]. 

However, the country has faced significant challenges tied to shortages of breast radiologists and screening quality. Dr. Xiaozhi Dang and colleagues investigated delivering ultrasound screenings across 46 community health centers in all six regions of China, transmitting the images via cloud to a single remote reading center. There, two subspecialized breast radiologists interpret the exams using BI-RADS, with a third rad resolving discrepancies. 

The program is delivering results, detecting about 4 cancers per 1,000 women, meeting benchmark performance metrics for cancer detection when compared to mammography, and unearthing infrequent interval cancers.

“This approach holds promise in enhancing access to screening and early detection in low-resource settings or underserved regions where mammographic screening is not established,” Dang, with the Department of Ultrasound at Xijing Hospital in Xi'an, China, and co-authors wrote Oct. 23. “Further studies with long-term follow-up are needed to determine whether the approach can contribute to better outcomes for patients with breast cancer,” they added. 

Dang and colleagues conducted the prospective study in 2021, enrolling asymptomatic women ages 35 to 69 across China. Participants underwent ultrasound as the sole screening modality, with technologists conducting the exams at community-based health centers. Radiologists returned their reports to the screening facilities, and patients received follow-up care at local hospitals. 

The final tally included 5,978 women at a median age of 46. Radiologists diagnosed a total of 24 ultrasound-detected cases and two instances of interval cancer. The abnormal interpretation rate was 11.9%, and a total of 95.8% of the ultrasound-detected cancers were invasive. These 23 cases had a median diameter of 10 mm and 73.9% were node-negative, the authors noted. Sensitivity was 92.3%, specificity 88.4%, and the biopsy rate was 1.7%. Positive predictive value of those cases was about 24%. 

Dang and colleagues see a future for this model, noting that radiology societies in American and Europe have discussed remote breast imaging to address workforce challenges. However, the study’s authors emphasized the importance of data security, quality assurance and compliance with healthcare regulations to ensure success. 

“A major obstacle to success of breast cancer screening programs is low participation rates in remote areas, with reduced access to health resources from geographic constraints and underdeveloped infrastructure,” the authors reported. “This study shows the potential of ABUS combined with teleradiology to enhance breast cancer screening access in resource-limited areas or in the context of global communities without mammography access. This approach could be integrated into radiology departments’ workflow to provide high-quality breast ultrasound services to remote areas lacking subspecialized breast radiologists.”