Ultrasound review was not unexpected

Ultrasound complements mammography as a diagnostic tool, explains Dr Muiris Houston , Medical Correspondent

In the climate of uncertainty surrounding breast cancer services in the State, some women may be alarmed at the news that a review of breast ultrasounds performed at the Midland Regional Hospital is now under way.

In fact, when questions about the quality of breast diagnostic services were first raised at the end of August, it was made clear by the Health Service Executive that the review would include breast ultrasounds as well as mammograms.

When setting up the review, Dr Ann O'Doherty, consultant radiologist at St Vincent's University Hospital, Dublin, and a clinical director of BreastCheck, advised that some 3,000 mammograms carried out between November 2003 and August 2007 be rechecked.

At the same time a review of the clinical notes of patients who had breast ultrasound examinations between August 2005 and August 2007 commenced.

Mammography is the basic screening investigation for a woman who develops breast symptoms. Essentially an X-ray of the breast, the process ends with the production of a hard copy of the test in the form of a traditional X-ray film.

An ultrasound of the breast, however, involves a more dynamic process carried out by a consultant radiologist using a jelly-covered probe. The ultrasound probe is placed on the skin overlying the breast and moved slowly over it.

Real time images are displayed on a computer monitor and the radiologist may decide to "capture" a number of images of the breast.

Typically the radiologist writes a one- or two-paragraph report on the ultrasound findings; this is filed in the patient's chart and a copy is sent to the referring doctor. But unlike mammography, breast ultrasound does not result in hard copy films that can be stored and subsequently retrieved. And because ultrasound images are unique to the operator, they do not lend themselves to formal review in the way mammograms can be reread.

Breast ultrasound is seen as complementary to mammography. It is more commonly used with younger women. In the case of a woman with a palpable breast lump, it offers greater diagnostic accuracy.

An ultrasound can tell whether the lump is full of fluid (a cyst) or if it is solid. When a breast biopsy is needed, ultrasound facilitates the accurate placing of a needle in the lump, thus ensuring that the specimen sent to the pathologist is actually from the precise area of the breast that is causing clinical concern.

If, following the detailed chart review process now under way in Portlaoise, a woman is recalled, then the follow-up will involve a repeat ultrasound; a clinical examination; and possibly a breast biopsy.

In effect, the woman will undergo the triple assessment that is now routine practice in specialist breast cancer centres.

© 2007 The Irish Times

This article appears in the print edition of the Irish Times