"Take Home Points

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Automated breast ultrasound (ABUS) is an emerging modality that can potentially improve reproducibility and reduce operator dependency associated with hand-held ultrasound (HHUS) in appropriately selected patients.

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Compared to HHUS, ABUS was associated with fewer abnormal interpretations and fewer short-interval follow-up recommendations and with a similar cancer detection rate.

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ABUS should be considered by healthcare providers as an effective alternative to handheld ultrasound for screening of certain women with dense breasts.

ABSTRACT

Objective

Supplemental ultrasound as an adjuvant to screening mammography has expanded due in part to the implementation of state laws mandating breast density notification. Automated breast ultrasound (ABUS) is an emerging modality that can potentially improve reproducibility and reduce operator dependency associated with hand-held ultrasound (HHUS) in appropriately selected patients. The goals of these analyses were to compare the performance of ABUS versus HHUS for women with dense breasts.

Methods

We used observational data from 21,110 HHUS and 4,218 ABUS exams among women with dense breasts conducted during 2017-2020 at 27 radiology facilities within three Breast Cancer Surveillance Consortium (BCSC) registries. Differences in abnormal interpretation rate, short-interval follow-up recommendation rate, biopsy recommendation rate, and cancer detection rate, as well as the false-positive initial assessment rate, false-positive biopsy recommendation rate, and positive predictive values for initial assessment and biopsy recommendation were compared.

Results

ABUS was associated with a lower abnormal interpretation rate (14.9% vs. 19.2%, p<0.0001), a lower short interval follow-up recommendation rate (3.0% vs. 14.6%, p<0.0001), and a lower false-positive initial assessment rate (14.6 vs. 19.1; p<0.0001) compared to HHUS. There were no apparent differences in biopsy recommendation or false-positive biopsy recommendation rate, positive predictive value, or cancer detection rate for ABUS versus HHUS.

Conclusion

Compared to HHUS, ABUS was associated with fewer abnormal interpretations and fewer short-interval follow-up recommendations and with a similar cancer detection rate. ABUS should be considered by healthcare providers as an effective alternative to handheld ultrasound for screening of certain women with dense breasts.