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. 2024 Aug;34(8):5451-5460.
doi: 10.1007/s00330-023-10568-5. Epub 2024 Jan 19.

Diagnostic performance of 3D automated breast ultrasound (3D-ABUS) in a clinical screening setting-a retrospective study

Femke Klein Wolterink  1 , Nazimah Ab Mumin  2 , Linda Appelman  3 , Monique Derks-Rekers  1 , Mechli Imhof-Tas  1 , Susanne Lardenoije  1 , Marloes van der Leest  1 , Ritse M Mann  4   5
Affiliations

Diagnostic performance of 3D automated breast ultrasound (3D-ABUS) in a clinical screening setting-a retrospective study

Femke Klein Wolterink et al. Eur Radiol. 2024 Aug.

Abstract

Objectives: To assess the diagnostic performance of 3D automated breast ultrasound (3D-ABUS) in breast cancer screening in a clinical setting.

Materials and methods: All patients who had 3D-ABUS between January 2014 and January 2022 for screening were included in this retrospective study. The images were reported by 1 of 6 breast radiologists based on the Breast Imaging Reporting and Data Systems (BI-RADS). The 3D-ABUS was reviewed together with the digital breast tomosynthesis (DBT). Recall rate, biopsy rate, positive predictive value (PPV) and cancer detection yield were calculated.

Results: In total, 3616 studies were performed in 1555 women (breast density C/D 95.5% (n = 3455/3616), breast density A/B 4.0% (n = 144/3616), density unknown (0.5% (n = 17/3616)). A total of 259 lesions were detected on 3D-ABUS (87.6% (n = 227/259) masses and 12.4% (n = 32/259) architectural distortions). The recall rate was 5.2% (n = 188/3616) (CI 4.5-6.0%) with only 36.7% (n = 69/188) cases recalled to another date. Moreover, recall declined over time. There were 3.4% (n = 123/3616) biopsies performed, with 52.8% (n = 65/123) biopsies due to an abnormality detected in 3D-ABUS alone. Ten of 65 lesions were malignant, resulting in a positive predictive value (PPV) of 15.4% (n = 10/65) (CI 7.6-26.5%)). The cancer detection yield of 3D-ABUS is 2.77 per 1000 screening tests (CI 1.30-5.1).

Conclusion: The cancer detection yield of 3D-ABUS in a real clinical screening setting is comparable to the results reported in previous prospective studies, with lower recall and biopsy rates. 3D-ABUS also may be an alternative for screening when mammography is not possible or declined.

Clinical relevance statement: 3D automated breast ultrasound screening performance in a clinical setting is comparable to previous prospective studies, with better recall and biopsy rates.

Key points: • 3D automated breast ultrasound is a reliable and reproducible tool that provides a three-dimensional representation of the breast and allows image visualisation in axial, coronal and sagittal. • The diagnostic performance of 3D automated breast ultrasound in a real clinical setting is comparable to its performance in previously published prospective studies, with improved recall and biopsy rates. • 3D automated breast ultrasound is a useful adjunct to mammography in dense breasts and may be an alternative for screening when mammography is not possible or declined.

Keywords: Breast cancer; Breast cancer screening; Digital breast tomosynthesis; Retrospective; Ultrasound.

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Conflict of interest statement

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Ritse Mann is member of the European Radiology Advisory Editorial Board. He has not taken part in the review or selection process of this article.

Figures

Fig. 1
Fig. 1
Flow chart diagram of the study population
Fig. 2
Fig. 2
Number of 3D-ABUS per patient in the study population and number of 3D-ABUS examinations throughout years from 2014 to 2021
Fig. 3
Fig. 3
Percentage of recalls, biopsies, and malignant cases for DBT and 3D-ABUS group throughout the study from 2014 to 2022
Fig. 4
Fig. 4
Percentage of recalls, biopsies, and malignant cases for 3D-ABUS alone throughout the study from 2014 to 2021
Fig. 5
Fig. 5
A 60-year-old woman with a history of breast cancer in the left breast. A There is an 8-mm lesion with architectural distortion in the left breast upper inner quadrant on 3D-ABUS (dashed circle). B Mammography of the left breast noted BI-RADS density C with surgical clips from previous surgery and no suspicious lesion was detected. Ultrasound-guided biopsy of the lesion confirmed invasive carcinoma NST, oestrogen receptor positive (50% positive), progesterone receptor, and HER-2 negative
Fig. 6
Fig. 6
A 70-year-old woman with a family history of breast cancer. A 3D-ABUS noted an ill-defined and lobulated hypoechoic lesion (dashed circle) measuring 10 mm at the left mid-inner region. B The left mammography noted BI-RADS density C with an irregular and ill-defined equal density mass at the left lower inner quadrant (dashed box). The lesion was biopsied under ultrasound guidance, with histopathology results of invasive papillary carcinoma, oestrogen-receptor positive, progesterone receptor, and HER-2 negative
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