Automated ultrasound cuts false positives in dense breast screening

Women with dense breast tissue may benefit from automated breast ultrasound (ABUS) as a reliable alternative to handheld ultrasound (HHUS), according to new research published in the Journal of the American College of Radiology. The study indicates that ABUS delivers comparable cancer detection rates but significantly lowers the incidence of false-positive results.

Screening capacity and demand

Radiology clinics face growing pressure to provide supplemental ultrasound screening alongside mammography. This surge follows state laws and federal regulations mandating that providers inform patients about the limitations of mammograms for those with dense breasts. Since both dense tissue and potential lesions appear white on standard mammograms, abnormalities can be obscured, making additional imaging crucial for accurate diagnosis.

While HHUS has been a staple in breast imaging for years, it suffers from operator dependency and inconsistent reproducibility. ABUS, approved in 2012 as an adjunct to screening mammography, represents an emerging technology designed to address these operational challenges. Researchers note that this is the first study to directly compare the clinical performance of ABUS against HHUS within United States practice settings.

Comparative data analysis

The investigation drew on clinical data from three diverse registries within the Breast Cancer Surveillance Consortium (BCSC). Analysts examined abnormal interpretation rates, short-interval follow-up (SIFU) recommendations, and associated cancer detection and false-positive metrics. The dataset comprised 25,328 screening ultrasound examinations performed on 21,446 women, interpreted by 98 radiologists across 27 facilities. Of these exams, 4,218 utilized ABUS, while 21,110 employed HHUS.

Garth H. Rauscher, PhD, lead investigator from the University of Illinois Chicago’s Division of Epidemiology and Biostatistics, highlighted the distinct advantage of the automated system. "ABUS was associated with a lower abnormal interpretation rate and a lower false-positive initial assessment rate compared with HHUS," Rauscher stated. He further clarified that there were no apparent differences in cancer detection rates, biopsy recommendation rates, or false-positive biopsy recommendation rates between the two methods.

Clinical implications

Brian L. Sprague, PhD, senior author and Co-Leader of the Population Sciences and Cancer Outcomes Program at the University of Vermont Cancer Center, emphasized the significance of these findings. "The results of our study provide the strongest evidence to date supporting the use of ABUS as an alternative to HHUS for supplemental screening of women with dense breasts," Sprague concluded.

The data suggests that ABUS reduces the need for additional imaging and SIFU recommendations without compromising diagnostic accuracy. By maintaining equivalent cancer detection capabilities while minimizing unnecessary follow-ups, ABUS offers a viable pathway to expand screening capacity in radiology clinics facing high demand.