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

Philadelpho, Fernanda; Calas, Maria Julia Gregorio; Carneiro, Gracy de Almeida Coutinho; Silveira, Isabela Cunha; Vaz, Andréia Brandão Ribeiro; Nogueira, Adriana Maria Coelho; Bergmann, Anke; Lopes, Flávia Paiva Proença Lobo

doi:10.1055/s-0040-1722156

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Original Article • Rev. Bras. Ginecol. Obstet. 43 (03) • Mar 2021 • https://doi.org/10.1055/s-0040-1722156 copy

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

Comparação entre a ultrassonografia automatizada e a ultrassonografia convencional no rastreio de mamas densas

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Keywords:
dense breast; screening; hand-held breast ultrasound; automated breast ultrasound; breast cancer

Characteristic	HHBUSN (%)	ABUSN (%)
Age (yr)
Median	48
Range	20–79
Breast parenchyma at mammography
Heterogeneously dense (C)	418 (95)
Extremely dense (D)	22 (5)
Pain (during ABUS)
Absence	–	292 (66.4)
Minimal	–	83 (18.9)
Mild	–	42 (9.5)
Severe	–	23 (5.2)
Final exams BI-RADS
1 (negative)	153 (34.8)	189 (42.9)
2 (benign)	188 (42.7)	201 (45.7)
3 (probably benign)	96 (21.8)	46 (10.5)
4 (suspicious)	3 (0.7)	4 (0.9)

Limitations	Patients
Artifacts	26 ^ 4 patients were excluded due to major artifacts (lack of adequate breast compression).
Firm Breast	24
Large breast	20
Small breast	16
Protruding sternum	15
Flabby breast	14
Total	115 (25.9%)

Lesions and BI-RADS	HHBUSN (%)	ABUSN (%)
Median (range) lesions sizes	0.86 cm (0.3–3.8 cm)	1.13 cm (0.5–3.0 cm)
BI-RADS 2 masses	15 (7.7)	12 (12.9)
BI-RADS 3 lesions	175 (89.3)	75 (80.0)
Solid masses	169 (86.3)	75 (80)
Clustered microcysts	4 (2)	0
Ductal ectasias	2 (1)	0
BI-RADS 4 masses	6 (3)	6 (6.4)

HHBUS	ABUS
3 spiculated masses (invasive ductal carcinomas)	3 spiculated masses (invasive ductal carcinomas)
1 complex mass (fibroadenoma)	Described as solid mass, BI-RADS 3
Not diagnosed by HHBUS	1 solid spiculated 1.3 cm mass (radial scar)
1 solid palpable 3.6 cm mass (fibroadenoma)	Described as solid mass, BI-RADS 3
Not diagnosed by HHBUS	1 solid intraductal 0.7 cm mass (papilloma)
1 complex 1.3 cm mass	Inflammatory cyst, described as BI-RADS 2
Not diagnosed by HHBUS	1 solid irregular 0.9 cm mass (invasive lobular carcinoma)

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[1] Address for correspondence Fernanda Philadelpho, MD, PhD, Av das Américas, 4666, sala 301 B, 22640-102, Centro Médico Barrashopping, Barra da Tijuca, Rio de Janeiro, RJ, Brazil (e-mail: fephila@gmail.com).