Comparison of Automated Breast Ultrasound and Hand-Held Breast Ultrasound in the Screening of Dense Breasts

Abstract Objective To compare hand-held breast ultrasound (HHBUS) and automated breast ultrasound (ABUS) as screening tool for cancer. Methods A cross-sectional study in patients with mammographically dense breasts was conducted, and both HHBUS and ABUS were performed. Hand-held breast ultrasound was acquired by radiologists and ABUS by mammography technicians and analyzed by breast radiologists. We evaluated the Breast Imaging Reporting and Data System (BI-RADS) classification of the exam and of the lesion, as well as the amount of time required to perform and read each exam. The statistical analysis employed was measures of central tendency and dispersion, frequencies, Student t test, and a univariate logistic regression, through the odds ratio and its respective 95% confidence interval, and with p<0.05 considered of statistical significance. Results Atotal of 440 patientswere evaluated. Regarding lesions,HHBUS detected 15 (7.7%) BI-RADS 2, 175 (89.3%) BI-RADS 3, and 6 (3%) BI-RADS 4, with 3 being confirmed by biopsy as invasive ductal carcinomas (IDCs), and 3 false-positives. Automated breast ultrasound identified 12 (12.9%) BI-RADS 2, 75 (80.7%) BI-RADS 3, and 6 (6.4%) BI-RADS 4, including 3 lesions detected by HHBUS and confirmed as IDCs, in addition to 1 invasive lobular carcinoma and 2 high-risk lesions not detected by HHBUS. The amount of time required for the radiologist to read the ABUS was statistically inferior compared with the time required to read the HHBUS (p<0.001). The overall concordance was 80.9%. A total of 219 lesions were detected, from those 70 lesions by both methods, 126 only by HHBUS (84.9% not suspicious by ABUS) and 23 only by ABUS. Conclusion Compared with HHBUS, ABUS allowed adequate sonographic study in supplemental screening for breast cancer in heterogeneously dense and extremely dense breasts.

摘要 目的：比较手持式乳腺超声（hand-held breast ultrasound, HHBUS）与自动乳腺超声（automated breast ultrasound, ABUS）作为癌症筛查工具的应用效果。方法：本研究针对乳腺钼靶提示致密型乳腺的患者开展横断面研究，所有受试者均接受HHBUS与ABUS检查。HHBUS由放射科医师操作完成，ABUS由乳腺钼靶技师操作，并由乳腺放射科医师完成阅片分析。本研究评估了检查及病灶的乳腺影像报告和数据系统（Breast Imaging Reporting and Data System, BI-RADS）分类，同时记录了每项检查的操作与阅片所需时长。本次研究采用的统计分析方法包括集中趋势与离散趋势指标、频数分布、t检验，以及基于比值比及其95%置信区间的单因素logistic回归分析，以p<0.05作为差异具有统计学意义的判定标准。结果：共纳入440例患者完成评估。针对检出病灶：HHBUS检出BI-RADS 2类病灶15个（7.7%）、BI-RADS 3类病灶175个（89.3%）、BI-RADS 4类病灶6个（3.0%），其中3个经活检证实为浸润性导管癌（invasive ductal carcinomas, IDCs），另有3个为假阳性病灶。ABUS检出BI-RADS 2类病灶12个（12.9%）、BI-RADS 3类病灶75个（80.7%）、BI-RADS 4类病灶6个（6.4%），其中包含3个经HHBUS检出并证实为IDCs的病灶，此外还检出1个浸润性小叶癌及2个HHBUS未检出的高危病灶。放射科医师阅ABUS的耗时显著低于阅HHBUS的耗时（p<0.001）。两种检查的总体一致性为80.9%。本研究共检出219个病灶，其中70个为两种方法均检出的病灶，126个仅由HHBUS检出（其中84.9%的病灶在ABUS中未被判定为可疑），23个仅由ABUS检出。结论：与HHBUS相比，ABUS可为不均质致密型及极度致密型乳腺的乳腺癌补充筛查提供充分的超声影像学评估。