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Breast
Imaging
Special Topics in Screening and Diagnostic Imaging
Automated Breast Ultrasound
Automated Breast Ultrasound
Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Diagnostic Checklist

        TERMINOLOGY

        • Abbreviations

          • Automated ultrasound (AUS)

        • Synonyms

          • Automated whole-breast ultrasound (ABUS)
          • Automated breast volume scan (ABVS)

        • Definitions

          • AUS: Systematic acquisition of US images of entire breast for later review by radiologist
            • Separates image acquisition from interpretation
          • Typically entails 3D volume acquisition of breast ± reconstructions
            • 15-cm footprint "reverse" curved array transducer, 14-6 or 15-6 MHz
              • Patient supine oblique (outer) or supine (inner breast)
              • Acquires 0.5-mm axial images for coronal and optional sagittal reconstructions
              • Overlapping acquisitions to cover entire breast: At least 3 (lateral, AP, medial), can require 5 or more (e.g., add superior, inferior)
              • ~ 60 seconds per acquisition
              • 318-340 images per acquisition → minimum of 900-1,000 images per breast
              • Nipple digitally marked by technologist to allow near coregistration of overlapping acquisitions for simultaneous (linked) review
            • Prone coronal 3D volume acquisition in water bath undergoing validation
              • Direct coronal acquisition
              • ~ 2 minute acquisition time per breast
          • Alternative approach: Automated arm with standard 3.5- to 5-cm footprint transducers
            • Overlapping axial acquisitions
            • 1,500-5,000 images per breast
          • Does not generally include axilla

        • General Performance Statistics

          • Meta-analysis (Meng) across 13 studies in > 1,600 women with lesions
            • Pooled sensitivity: 92% (95%CI 89.9 to 93.8)
            • Pooled specificity: 84.9% (95%CI 82.4 to 87.0)
            • AUC 0.967
            • Sensitivity = handheld ultrasound (HHUS); lower specificity where compared
          • Inter-reader agreement for benign vs. malignant assessment: κ = 0.50
          • At least 1-2 month learning curve with expected high recall rate (20-25%) due to artifactual shadowing at interface of fat lobules
            • Review overlapping images of same area to exclude true lesion

        IMAGING

        • Indications

          • Contraindications

            DIAGNOSTIC CHECKLIST

            • Consider

              • Image Interpretation Pearls

                Selected References

                1. Girometti R et al: Automated breast volume scanner (ABVS) in assessing breast cancer size: A comparison with conventional ultrasound and magnetic resonance imaging. Eur Radiol. 28(3):1000-1008, 2018
                2. van Zelst JCM et al: Dedicated computer-aided detection software for automated 3D breast ultrasound; an efficient tool for the radiologist in supplemental screening of women with dense breasts. Eur Radiol. ePub, 2018
                3. Zanotel M et al: Automated breast ultrasound: basic principles and emerging clinical applications. Radiol Med. 123(1):1-12, 2018
                4. Girometti R et al: Comparison between automated breast volume scanner (ABVS) versus hand-held ultrasound as a second look procedure after magnetic resonance imaging. Eur Radiol. 27(9):3767-3775, 2017
                5. Hellgren R et al: Comparison of handheld ultrasound and automated breast ultrasound in women recalled after mammography screening. Acta Radiol. 58(5):515-520, 2017
                6. Giger ML et al: Automated breast ultrasound in breast cancer screening of women with dense breasts: Reader study of mammography-negative and mammography-positive cancers. AJR Am J Roentgenol. 206(6):1341-50, 2016
                7. Kim Y et al: Prospective Study Comparing Two Second-Look Ultrasound Techniques: Handheld Ultrasound and an Automated Breast Volume Scanner. J Ultrasound Med. 35(10):2103-12, 2016
                8. Wilczek B et al: Adding 3D automated breast ultrasound to mammography screening in women with heterogeneously and extremely dense breasts: Report from a hospital-based, high-volume, single-center breast cancer screening program. Eur J Radiol. 85(9):1554-63, 2016
                9. Brem RF et al: Assessing improvement in detection of breast cancer with three-dimensional automated breast US in women with dense breast tissue: the SomoInsight Study. Radiology. 274(3):663-73, 2015
                10. Meng Z et al: Diagnostic performance of the automated breast volume scanner: a systematic review of inter-rater reliability/agreement and meta-analysis of diagnostic accuracy for differentiating benign and malignant breast lesions. Eur Radiol. 25(12):3638-47, 2015
                11. Lin X et al: Analysis of eighty-one cases with breast lesions using automated breast volume scanner and comparison with handheld ultrasound. Eur J Radiol. 81(5):873-8, 2012
                12. Kelly KM et al: Breast cancer detection using automated whole breast ultrasound and mammography in radiographically dense breasts. Eur Radiol. 20(3):734-42, 2010
                13. Kelly KM et al: Breast cancer detection: radiologists' performance using mammography with and without automated whole-breast ultrasound. Eur Radiol. 20(11):2557-64, 2010
                Related Anatomy
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                References
                Tables

                Tables

                KEY FACTS

                • Terminology

                  • Imaging

                    • Diagnostic Checklist

                      TERMINOLOGY

                      • Abbreviations

                        • Automated ultrasound (AUS)

                      • Synonyms

                        • Automated whole-breast ultrasound (ABUS)
                        • Automated breast volume scan (ABVS)

                      • Definitions

                        • AUS: Systematic acquisition of US images of entire breast for later review by radiologist
                          • Separates image acquisition from interpretation
                        • Typically entails 3D volume acquisition of breast ± reconstructions
                          • 15-cm footprint "reverse" curved array transducer, 14-6 or 15-6 MHz
                            • Patient supine oblique (outer) or supine (inner breast)
                            • Acquires 0.5-mm axial images for coronal and optional sagittal reconstructions
                            • Overlapping acquisitions to cover entire breast: At least 3 (lateral, AP, medial), can require 5 or more (e.g., add superior, inferior)
                            • ~ 60 seconds per acquisition
                            • 318-340 images per acquisition → minimum of 900-1,000 images per breast
                            • Nipple digitally marked by technologist to allow near coregistration of overlapping acquisitions for simultaneous (linked) review
                          • Prone coronal 3D volume acquisition in water bath undergoing validation
                            • Direct coronal acquisition
                            • ~ 2 minute acquisition time per breast
                        • Alternative approach: Automated arm with standard 3.5- to 5-cm footprint transducers
                          • Overlapping axial acquisitions
                          • 1,500-5,000 images per breast
                        • Does not generally include axilla

                      • General Performance Statistics

                        • Meta-analysis (Meng) across 13 studies in > 1,600 women with lesions
                          • Pooled sensitivity: 92% (95%CI 89.9 to 93.8)
                          • Pooled specificity: 84.9% (95%CI 82.4 to 87.0)
                          • AUC 0.967
                          • Sensitivity = handheld ultrasound (HHUS); lower specificity where compared
                        • Inter-reader agreement for benign vs. malignant assessment: κ = 0.50
                        • At least 1-2 month learning curve with expected high recall rate (20-25%) due to artifactual shadowing at interface of fat lobules
                          • Review overlapping images of same area to exclude true lesion

                      IMAGING

                      • Indications

                        • Contraindications

                          DIAGNOSTIC CHECKLIST

                          • Consider

                            • Image Interpretation Pearls

                              Selected References

                              1. Girometti R et al: Automated breast volume scanner (ABVS) in assessing breast cancer size: A comparison with conventional ultrasound and magnetic resonance imaging. Eur Radiol. 28(3):1000-1008, 2018
                              2. van Zelst JCM et al: Dedicated computer-aided detection software for automated 3D breast ultrasound; an efficient tool for the radiologist in supplemental screening of women with dense breasts. Eur Radiol. ePub, 2018
                              3. Zanotel M et al: Automated breast ultrasound: basic principles and emerging clinical applications. Radiol Med. 123(1):1-12, 2018
                              4. Girometti R et al: Comparison between automated breast volume scanner (ABVS) versus hand-held ultrasound as a second look procedure after magnetic resonance imaging. Eur Radiol. 27(9):3767-3775, 2017
                              5. Hellgren R et al: Comparison of handheld ultrasound and automated breast ultrasound in women recalled after mammography screening. Acta Radiol. 58(5):515-520, 2017
                              6. Giger ML et al: Automated breast ultrasound in breast cancer screening of women with dense breasts: Reader study of mammography-negative and mammography-positive cancers. AJR Am J Roentgenol. 206(6):1341-50, 2016
                              7. Kim Y et al: Prospective Study Comparing Two Second-Look Ultrasound Techniques: Handheld Ultrasound and an Automated Breast Volume Scanner. J Ultrasound Med. 35(10):2103-12, 2016
                              8. Wilczek B et al: Adding 3D automated breast ultrasound to mammography screening in women with heterogeneously and extremely dense breasts: Report from a hospital-based, high-volume, single-center breast cancer screening program. Eur J Radiol. 85(9):1554-63, 2016
                              9. Brem RF et al: Assessing improvement in detection of breast cancer with three-dimensional automated breast US in women with dense breast tissue: the SomoInsight Study. Radiology. 274(3):663-73, 2015
                              10. Meng Z et al: Diagnostic performance of the automated breast volume scanner: a systematic review of inter-rater reliability/agreement and meta-analysis of diagnostic accuracy for differentiating benign and malignant breast lesions. Eur Radiol. 25(12):3638-47, 2015
                              11. Lin X et al: Analysis of eighty-one cases with breast lesions using automated breast volume scanner and comparison with handheld ultrasound. Eur J Radiol. 81(5):873-8, 2012
                              12. Kelly KM et al: Breast cancer detection using automated whole breast ultrasound and mammography in radiographically dense breasts. Eur Radiol. 20(3):734-42, 2010
                              13. Kelly KM et al: Breast cancer detection: radiologists' performance using mammography with and without automated whole-breast ultrasound. Eur Radiol. 20(11):2557-64, 2010