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

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

Reviewer: Jessica Coffey | ASA SIG: Women’s Health

Authors: Klein Wolterink F, Ab Mumin N, Appelman L, Derks-Rekers M, Imhof-Tas M, Lardenoije S, van der Leest M & Mann RM

Why the study was performed

Screening plays an important role in the early detection of breast cancer, with mammography used as the gold standard modality. Mammography is less sensitive in women with dense breast tissue due to the overlapping fibroglandular tissue. 3D automated breast ultrasound (3D-ABUS) has been proposed as a potential supplementary modality to improve cancer detection, specifically in this group of women. Several prospective studies of the performance of 3D-ABUS have reported additional cancer detection and increased sensitivity. However, they have also shown a decrease in specificity and an increase in the recall and biopsy rates. This study was conducted to evaluate the diagnostic performance of 3D-ABUS as a supplementary modality for breast cancer screening in a real clinical setting.

How the study was performed

This was a retrospective study of all patients who underwent 3D-ABUS for breast cancer screening at Radboud University Medical Centre in the Netherlands between January 2014 and January 2022. 3D-ABUS was offered in addition to mammography to all women undergoing clinical screening who had Volpara breast density C and D. 3D-ABUS alone was also offered to women who declined mammography or were younger than the mammography recommended age. Cases referred for diagnostic imaging were not included. 3D-ABUS and mammography were performed by trained radiographers using Seimens Acuson s2000 Automated Breast Volume Scanner Ultrasound System and Seimens Mammomat Revelation or Mammomat Inspiration machines. Studies were reviewed by one of six breast radiologists who had undergone training in the application and reading of 3D-ABUS before the installation of the machine. Statistical analyses were performed using IBM SPSS version 25 software.

What the study found

In total, 3616 3D-ABUS studies were performed in 1555 women over the 8-year trial. Of these, 152 examinations on 104 women were performed without mammography. The study found an additional cancer yield of 2.77 per 1000 screening tests. The overall recall rate was 5.2%, with a significant reduction over the time of the study (23.6% in the first year and 3.8% by year 8). The biopsy rate was 1.8%, with 52.8% of biopsies performed due to an abnormality detected on 3D-ABUS alone. The positive predictive value was 15.4%. These results are comparable in performance to previous prospective studies, with better recall and biopsy rates. The majority of cancers detected by 3D-ABUS alone were IDC, whereas the majority of cancers detected by mammography alone were DCIS.

Relevance to clinical practice

The findings of this study support the integration in clinical practice of 3D-ABUS as a supplemental screening tool for women with dense breast tissue. However, this would need to be balanced with the challenge of increased biopsy and recall rates, which are a source of anxiety for patients, as well as the additional costs of equipment, training and examination time.

“3D automated ultrasound screening performance in a clinical setting is comparable to previous prospective studies, with better recall and biopsy rates”