Automated breast ultrasound led to sharp increases in cancer detection rates and sensitivity when it was performed as a supplement to screening digital mammography in a study of Asian women.
In Radiology, researchers from South Korea explain the shortcomings of X-ray-based mammography, which has limited sensitivity in women with dense breast tissue. Handheld ultrasound can be used as a screening supplement, but it has drawbacks of its own, such as longer exam time and operator variability.
ABUS has been proposed as an alternative, acquiring 3D volumes of the entire breast in an automated mode that’s more structured and standardized. ABUS also provides coronal-plane images that can help differentiate malignant from benign lesions.
But most of the studies validating ABUS have been conducted on Western women, and Asian women tend to have mammographically denser breasts.
So researchers decided to test ABUS as a supplement to digital mammography with 2,301 South Korean women who were screened from 2018 to 2019. Women were first screened with digital mammography (either Hologic’s Selenia Dimensions or Siemens Healthineers’ Mammomat Revelation), then received ABUS scans with GE HealthCare’s Invenia ABUS system.
For women with dense breasts, screening with ABUS and DM turned in better performance than DM alone in multiple categories, including:
- Higher cancer detection rate per 1,000 screening exams (9.3 vs. 6.5)
- Better sensitivity (90.9% vs. 63.6%)
- Higher AUC (0.89 vs. 0.79)
- Detection of smaller cancers, with a mean size of 1.2 cm vs. 2.3 cm
On the down side, ABUS + DM in women with dense breasts had lower specificity (86.8% vs. 94.6%), driving higher biopsy rates (3.3% vs. 1.9%) and false-positive biopsy rates (2.4% vs. 1.3%).
In a time when breast cancer inequities are under the microscope, the new study provides encouraging news that imaging technology can help compensate for the shortcomings of the traditional “one size fits all” paradigm of breast screening.
The results are also a shot in the arm for ABUS as it seeks to cement a role as a complement to X-ray-based screening mammography, although work remains to be done in improving specificity and recall rates.