Do automated breast ultrasound and tomosynthesis have an effective role in dense breast evaluation?

Background Mammography plays a great role in reducing breast cancer mortality as it is the standard method of breast imaging and screening. But the accuracy of mammography performance reduces in cancer detection in women with dense breast due to the summation of images and overlapping of breast tissue. ABUS and tomosynthesis both recently help to detect breast cancer in dense breasted women. This prospective study was done in the female imaging unit and approved by its research and ethical committee; all the patients did an informed consent during the period from October 2018 to March 2019. The study was conducted on 38 patients with 38 lesions subjected to digital mammography, tomosynthesis and automated breast ultrasound (ABUS), who all had dense breast in mammography. Results Automated breast ultrasound (ABUS) showed 100% in all sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) as well as accuracy, while the digital mammography tomosynthesis showed 100% in specificity, 87.5% in sensitivity, 100% in PPV, 82.4% in NPV and 92.1% accuracy. Conclusion Automated breast ultrasound (ABUS) together with tomosynthesis makes a revolution in breast screening and detecting cancer in women with dense breasts.

Does automated breast ultrasound (ABUS) add to breast tomosynthesis (DBT) in assessment of lesions in dense breasts?

Background As mammography has its known limitations in dense breast, additional imaging is usually needed. We aimed to evaluate the role of automated breast ultrasound in addition to tomosynthesis in detection and diagnosis of breast lesions in dense breasts. Seventy patients with dense breasts subjected to full-field digital mammography (FFDM) including digital breast tomosynthesis (DBT) and automated breast ultrasound (ABUS). Both studies were evaluated by two experienced radiologists to assess breast composition, mass characterization, asymmetry, calcification, axillary lymphadenopathy, extent of disease (EOD), skin thickening, retraction, architectural distortion, and BIRADS classification. All breast masses were interpreted as above described and then correlated with final pathological diagnosis. Results Study included 70 females presenting with different types of breast lesions. Eighty-two masses were detected: 53 benign (n = 53/82), 29 malignant (n = 29/82). Histopathology of the masses was reached by core biopsy (n = 30), FNAC (n = 14), and excisional biopsy (n = 11). The rest of the masses (n = 27/82) were confirmed by their characteristic sonographic appearances; 20 cases of multiple bilateral anechoic simple cysts, 7 typical fibroadenomas showed stationary course on follow-up. As regards the final BIRADS score given for both modalities, tomosynthesis showed accuracy of 93.1% in characterization of malignant masses with accuracy of 94.3% in benign masses, on the other hand automated ultrasound showed 100% accuracy in characterization of malignant masses with 98.1% accuracy in benign masses. Conclusion Adding ABUS to tomosynthesis has proven a valuable imaging tool for characterization of breast lesions in dense breasts both as screening and diagnostic tool. They proved to be more sensitive and specific than digital mammography alone in showing tissue overlap, tumor characterization, lesion margins, extent, and multiplicity of malignant lesions.

Pros and Cons for Automated Breast Ultrasound (ABUS): A Narrative Review

Automated breast ultrasound (ABUS) is an ultrasound technique that tends to be increasingly used as a supplementary technique in the evaluation of patients with dense glandular breasts. Patients with dense breasts have an increased risk of developing breast cancer compared to patients with fatty breasts. Furthermore, for this group of patients, mammography has a low sensitivity in detecting breast cancers, especially if it is not associated with architectural distortion or calcifications. ABUS is a standardized examination with many advantages in both screening and diagnostic settings: it increases the detection rate of breast cancer, improves the workflow, and reduces the examination time. On the other hand, like any imaging technique, ABUS has disadvantages and even some limitations. Many disadvantages can be diminished by additional attention and training. Disadvantages regarding image acquisition are the inability to assess the axilla, the vascularization, and the elasticity of a lesion, while concerning the interpretation, the disadvantages are the artifacts due to poor positioning, lack of contact, motion or lesion related. This article reviews and discusses the indications, the advantages, and disadvantages of the method and also the sources of error in the ABUS examination.

Automated Breast Ultrasound: Technical Aspects, Impact on Breast Screening, and Future Perspectives

Purpose of Review Automated breast ultrasound (ABUS) is a three-dimensional imaging technique, used as a supplemental screening tool in women with dense breasts. This review considers the technical aspects, pitfalls, and the use of ABUS in screening and clinical practice, together with new developments and future perspectives. Recent Findings ABUS has been approved in the USA and Europe as a screening tool for asymptomatic women with dense breasts in addition to mammography. Supplemental US screening has high sensitivity for cancer detection, especially early-stage invasive cancers, and reduces the frequency of interval cancers. ABUS has similar diagnostic performance to handheld ultrasound (HHUS) and is designed to overcome the drawbacks of operator dependence and poor reproducibility. Concerns with ABUS, like HHUS, include relatively high recall rates and lengthy reading time when compared to mammography. ABUS is a new technique with unique features; therefore, adequate training is required to improve detection and reduce false positives. Computer-aided detection may reduce reading times and improve cancer detection. Other potential applications of ABUS include local staging, treatment response evaluation, breast density assessment, and integration of radiomics. Summary ABUS provides an efficient, reproducible, and comprehensive supplemental imaging technique in breast screening. Developments with computer-aided detection may improve the sensitivity and specificity as well as radiologist confidence and reduce reading times, making this modality acceptable in large volume screening centers.

First proof-of-concept evaluation of the FUSION-X-US-II prototype for the performance of automated breast ultrasound in healthy volunteers

Purpose The FUSION-X-US-II prototype was developed to combine 3D-automated breast ultrasound (ABUS) and digital breast tomosynthesis in a single device without decompressing the breast. We evaluated the technical function, feasibility of the examination workflow, image quality, breast tissue coverage and patient comfort of the ABUS device of the new prototype. Methods In this prospective feasibility study, the FUSION-X-US-II prototype was used to perform ABUS in 30 healthy volunteers without history of breast cancer. The ABUS images of the prototype were interpreted by a physician with specialization in breast diagnostics. Any detected lesions were measured and classified using BI-RADS® scores. Image quality was rated subjectively by the physician and coverage of the breast was measured. Patient comfort was evaluated by a questionnaire after the examination. Results One hundred and six scans were performed (61 × CC, 23 × ML, 22 × MLO) in 60 breasts. Image acquisition and processing by the prototype was fast and accurate. Breast coverage by ABUS was approximately 90.8%. Sixteen breast lesions (all benign, classified as BIRADS® 2) were identified. The examination was tolerated by all patients. Conclusion The FUSION-X-US-II prototype allows a rapid ABUS scan with mostly high patient comfort. Technical developments resulted in an improvement of quality and coverage compared to previous prototype versions. The results are encouraging for a test of the prototype in a clinical setting in combination with tomosynthesis.