Comparison of automated breast ultrasonography to handheld ultrasonography in detecting and diagnosing breast lesions

Background: Automated breast ultrasonography (ABUS) is increasingly used as a screening tool. Several studies have demonstrated a similar diagnostic performance for ABUS compared with handheld ultrasonography (HHUS), but the overall results have been controversial. Purpose: To compare the clinical utility of ABUS and HHUS for detection and diagnosis of breast lesions. Material and Methods: ABUS and HHUS images of suspicious breast lesions were obtained for 173 consecutive women scheduled to undergo ultrasonography (US)-guided or stereotactic biopsy. There were a total of 206 lesions, 46 of which were malignant and 160 benign. Three breast radiologists took part in this study: two reviewed the ABUS images, and the third reviewed all of the images, ABUS and HHUS, as well as the patients' medical records. The biopsied-lesion-detection rates were obtained. Using the Breast Imaging Reporting and Data System (BI-RADS), the images of the biopsied lesions were evaluated. Factors affecting ABUS detectability were analyzed. Results: The overall detection rates were 83.0% for ABUS and 94.2% for HHUS. Ten lesions were not detected on either HHUS or ABUS and these were microcalcifications (one malignancy and nine benign lesions). Of the 194 HHUS-detected lesions, 169 were detected by ABUS and 25 benign were not. ABUS less frequently detected lesions of smaller size as well as those of benign appearance and lower final-assessment category (P=0.011 and P<0.0001, respectively). Conclusion: ABUS detected all of the malignant lesions that were detected on HHUS. ABUS missed several smaller benign lesions.