Women's perspectives on ultrasound as primary imaging modality for focal breast complaints: a qualitative study.

Abstract

Objectives: The breast ultrasound trial (BUST) demonstrates a high negative predictive value of ultrasound for women presenting with focal breast complaints, suggesting a potential shift from mammography/digital breast tomosynthesis (DBT) to ultrasound as a primary imaging modality. This BUST side-study explored women's perspectives on adopting ultrasound as the primary diagnostic tool.

Methods: Twenty-nine female BUST participants (mean age = 48.4, SD = 8.3) with benign findings after diagnostic evaluation participated in one of six focus group interviews 18-24 months post-imaging. Discussions were transcribed and analyzed thematically.

Results: Four overarching themes were identified; personal health situation, organization of breast care, effectiveness of imaging, and professionals' attitudes and roles. Participants considered their own health history and complaint type (personal health situation) and discussed eligibility for national screening programs and the costs of both exams (organization of breast care). Opinions varied on the effectiveness of imaging, particularly regarding the importance of detecting additional non-symptomatic findings with mammography/DBT that may be missed by ultrasound. Concerns were also raised about implementing research findings without conclusive scientific evidence. Health professionals' attitudes and roles encompassed the influence of GPs' and radiologists' attitudes and the process of image interpretation.

Conclusion: These findings reveal diverse attitudes of women towards ultrasound as a primary modality, warranting caution when transitioning to new clinical standards. Providing comprehensive information about the evidence on the benefits and risks of different imaging modalities is essential, and fostering shared decision-making could enhance acceptance. Offering women the choice of additional imaging, such as mammography/DBT after an initial ultrasound, may balance clinical performance with patient autonomy.

Critical relevance statement: Patients' perspectives on medical procedures are increasingly significant in modern healthcare. Women's perceived barriers and facilitators to diagnostic imaging, shaped by numerous factors, offer healthcare professionals insights beyond pure biomedical approaches, fostering shared decision-making within radiology and other clinical contexts.

Key points: This study explores women's perspectives on breast ultrasound as a primary imaging modality. Attitudes towards an ultrasound-first approach are shaped by internal and external considerations. Considerations are highly informed by emotional responses and lack of knowledge. Insights into women's perspectives inform healthcare professionals and foster shared decision-making within radiology.