Automated Breast Ultrasound: Is it a Viable Second-Look Option for Women with Dense Breasts?

The adjunctive use of automated breast ultrasound (ABUS) offers a 27 percent higher sensitivity rate for breast cancer detection in comparison to mammography (MAM) alone and a 25 percent lower false-positive rate in comparison to adjunctive handheld ultrasound (HHUS) for women aged 55 to 64 with dense breasts, according to newly published research.

For the multicenter study, recently published in Academic Radiology, researchers compared the use of MAM/ABUS to MAM/HHUS and MAM alone in a total of 19,171 asymptomatic women from six hospitals in China. All study participants had adjunctive HHUS and ABUS and women 45 years of age and older also had MAM alone, according to the study, which was conducted between February 2018 and August 2022.

The researchers found that adjunctive use of either ABUS or HHUS had a 3.66 percent cancer detection rate (CDR) per 1,000 screens in comparison to 2.69 percent per 1,000 screens for MAM alone. Both ultrasound modalities had a 94.44 percent sensitivity rate in combination with MAM, which was 25 percent higher than the sensitivity rate for MAM alone (69.44 percent), according to the study.

“To our knowledge, this is the first multi-center population-based screening study to directly compare HHUS and ABUS as adjunct modalities in the same women with average risk. We found that the addition of two (ultrasound modalities) both led to significantly higher incremental breast cancer detection than MAM alone, especially in women aged 45 to 54 years with denser breasts,” wrote study co-author Fanghui Zhao, M.D., Ph.D., who is affiliated with the Department of Cancer Epidemiology at the National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital at the Chinese Academy of Medical Sciences and Peking Union Medical College in Beijing, China.

(Editor’s note: For related content, see “Mammography Study Shows 22 Percent Higher Incidence of Dense Breasts in Women with a Family History of Breast Cancer,” “Looking at Next Steps to Reinforce National Breast Density Notification” and “Current Insights on National Breast Density Notification for Mammography Reports.”)

For women aged 45 to 54 who had more dense breasts (including 5th edition BI-RADS categories C (heterogeneous density) and D (extremely dense)), the study authors found that adjunctive ABUS had a higher sensitivity rate (96.55 percent) than that of adjunctive HHUS (93.10 percent) and MAM alone (72.41 percent).

The researchers also noted that adjunctive ABUS had an overall 10 percent lower false positive rate than adjunctive HHUS. The difference was more pronounced among patients with more dense breasts with researchers noting that adjunctive ABUS had a 25 percent lower false-positive rate than adjunctive HHUS for women 55 to 64 years of age with dense breasts.

“The standardized review process allows ABUS to be viewed as a potential solution for reducing the high variation among operators using HHUS. Another advantage is that it can be automatically reconstructed to 3D views and allow interpretation in the addition(al) plane (coronal), providing more information to help detect lesions,” pointed out Zhao and colleagues.

In regard to study limitations, the researchers noted the high dropout rate for women who were recommended to have a biopsy may have impacted the accuracy of the cancer detection rates reported in the study. They also conceded that a lack of information on pathology characteristics of women with diagnosed breast cancer limited the assessment of the impact of supplemental ultrasound upon breast cancer staging.