Diagnostic Performance of Automated Breast Volume Scanning (ABVS) Compared to Handheld Ultrasonography With Breast MRI as the Gold Standard

Rationale and Objectives

This study aimed to compare the diagnostic value of automated breast volume scanning (ABVS) to that of handheld ultrasonography (HHUS) using breast magnetic resonance imaging (MRI) as the gold standard.

Materials and Methods

Twenty-eight patients with 39 examined breasts with at least one lesion visible in breast MRI underwent HHUS and ABVS. Detection rate, localization, maximum diameter, and Breast Imaging Reporting and Data System classification were compared. Sensitivity, specificity, diagnostic accuracy, positive predictive value, and negative predictive value were calculated for HHUS and ABVS. Lesion localization and maximum diameters based on HHUS and ABVS were compared to size measurement in MRI. Breast Imaging Reporting and Data System categories based on each method were compared to the MRI diagnosis (malignant or benign) or, if available (21 cases), with the histologic diagnosis.

Results

MRI detected 72 lesions, ABVS 59 lesions, and HHUS 54 lesions. Malignancy was proven histopathologically in 15 cases. There was no significant difference between ABVS and HHUS in terms of sensitivity (93.3% vs. 100%), specificity (83.3% vs. 83.3%), diagnostic accuracy (87.2% vs. 89.7%), positive predictive value (77.8% vs. 78.9%), and negative predictive value (95.2% vs. 100%). Agreement regarding lesion localization (same quadrant) was 94.3% for ABVS and MRI and 91.2% for HHUS and MRI. Lesion size compared to MRI lesion size was assessed correctly (+/− 3 mm) in 79.4% (HHUS) and 80% (ABVS). The correlation of size measurement was slightly higher for ABVS-MRI (r = 0.89) than for HHUS-MRI (r = 0.82) with P < .001.

Conclusions

ABVS can be used as an alternative to HHUS. ABVS has the advantage of operator independence and better reproducibility although it is limited in evaluating axillary lymph nodes and lacks Doppler or elastrography capabilities, which sometimes provide important supplementary information in HHUS.

Introduction

Magnetic resonance imaging of the breast (breast MRI) is typically performed in women at higher risk for breast cancer (eg BRCA-1 or BRCA-2 mutation). In Germany, most of these women are enrolled in special breast cancer screening programs, which include a breast MRI examination once a year . Other indications for breast MRI are inconclusive findings of mammography and handheld ultrasonography (HHUS) or the need to evaluate preoperative tumor extent, for example, in case of multifocality. Although breast MRI is highly sensitive, it has variable specificity and a high false-positive rate . Therefore, two-dimensional HHUS is also used as a second-look imaging test to reduce the false-positive rate, by easily identifying lymph nodes or fibroadenomas, classified as nonspecific enhancing lesions by MRI . The other advantage of second-look ultrasound is that it can help in deciding about the biopsy guidance method (ultrasound or MRI). Ultrasound-guided biopsy is preferred to MRI-guided biopsy and can be performed whenever the suspicious breast lesion is detectable by ultrasound . However, because HHUS is very operator-dependent, nonreproducible, and inefficient in the diagnosis of some breast malignancies (especially ductal carcinoma in situ [DCIS]) , the present study was conducted to investigate whether an automated breast volume scanner (ABVS) could overcome these limitations of HHUS.

The ABVS acquires a whole series of consecutive B-mode images by scanning the whole breast in a straight line in anterior-posterior, lateral, and medial directions (and if necessary, eg in women with large breasts, additionally in superior and inferior directions). The acquired images are sent to a separate workstation and are then used to reconstruct three-dimensional (3D) datasets of the entire breast volume including coronal, axial, and sagittal views. The resulting datasets can then be analyzed by a radiologist. Thus, ABVS provides consistent, reproducible, and operator-independent ultrasound imaging of the entire breast . The examination takes 10 minutes and can be performed by a technologist. Interpretation by a radiologist at the workstation takes another 5 minutes .

Materials and Methods

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Results

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Table 1

Histologic Diagnosis of 21 Lesions

Histologic Diagnosis Number Ductal carcinoma in situ 1 Invasive ductal carcinoma 10 Invasive lobular carcinoma 2 Invasive medullary carcinoma 1 Invasive carcinoma of no special type 1 Fibrocystic mastopathia 4 Microglandular adenosis 2

Table 2

Basic Lesion Features

No. in MRI Average Size in Millimeter Enhancement in MRI Enhancement Initial Phase Delayed Phase ABVS HHUS MRI Fast Medium Slow Washout Plateau Persistent Histologic diagnosis Ductal carcinoma in situ 1 3 6 100 Mass Non-mass 1 1 Invasive ductal carcinoma 10 17 18 20 Mass 7 3 7 3 Non-mass Invasive lobular carcinoma 2 8 9 9 Mass 1 1 Non-mass 1 1 Invasive medullary carcinoma 1 11 12 13 Mass Non-mass 1 1 Invasive cancer of non–special type 1 11 10 11 Mass 1 1 Non-mass Fibrocystic mastopathy 4 ( n = 3) 16 17 10 Mass 1 1 Non-mass 1 2 3 Microglandular adenosis 2 ( n = 1) 10 5 13 Mass Non-mass 1 1 1 1 Imaging diagnosis Lymph node or fibroadenoma 16 ( n = 13) 7 6 7 Mass 4 6 6 1 2 13 Non-mass Mastopathy 2 15 14 16 Mass Non-mass 2 2

ABVS, automated breast volume scanning; HHUS, handheld ultrasonography; MRI, magnetic resonance imaging.

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Table 3

Sensitivity, Specificity, Diagnostic Accuracy, Positive Predictive Value, and Negative Predictive Value for HHUS and ABVS

Sensitivity Specificity Diagnostic Accuracy PPV NPV HHUS 100.0% 83.3% 89.7% 78.9% 100.0% ABVS 93.3% 83.3% 87.2% 77.8% 95.2%

ABVS, automated breast volume scanning; HHUS, handheld ultrasonography.

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Table 4

Rate of Malignancy

BI-RADS HHUS ABVS MRI 1 — — — 2 — — — 3 — 1 — 4a — — — 4b — 1 1 4c 2 3 2 5 13 10 12

ABVS, automated breast volume scanning; BI-RADS, Breast Imaging Reporting and Data System; DCIS, ductal carcinoma in situ; HHUS, handheld ultrasonography; MRI, magnetic resonance imaging.

The BI-RADS 3 in ABVS was the DCIS.

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Table 5

Accordance in Describing the Localizations of the Most Suspicious/Largest Lesions

HHUS and MRI ( n = 34) ABVS and MRI ( n = 35) Same quadrant 31/34 (91.2%) 33/35 (94.3%) Different quadrants 3/34 (8.8%) 2/35 (5.7%)

ABVS, automated breast volume scanning; HHUS, handheld ultrasonography; MRI, magnetic resonance imaging.

Table 6

Size Assessment Made With HHUS and ABVS With Lesion Size in MRI as Reference

HHUS ( n = 34) ABVS ( n = 35) Accurate estimation 27 (79.4%) 28 (80.0%) Underestimation 5 (14.7%) 5 (14.3%) Overestimation 2 (5.9%) 2 (5.7%)

ABVS, automated breast volume scanning; HHUS, handheld ultrasonography; MRI, magnetic resonance imaging.

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Discussion

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Acknowledgment

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