Objective The purpose of this study was to reevaluate the high-risk breast non-mass-like lesions (NMLs) in mammography (MG) by target ultrasound (US) and Automated breast ultrasonography (ABUS), and to analyze the correlation between different imaging findings and the factors influencing the classification of lesions. Methods A total of 161 patients with 166 breast lesions were recruited in this retrospectively study. All cases were diagnosed as BI-RADS 4 or 5 by MG and as NML on ultrasound. While all NMLs underwent mammography, target US and ABUS before breast surgery or biopsy in the consistent position of breast. The imaging and pathological features of all cases were collected. All lesions were classified according to the lexion of ACR BI-RADS®. Results There were significant differences between benign and malignant breast NML in all the features of target US and ABUS. US, especially ABUS, was superior to MG in determining the malignant breast NML. There was a significant difference in the detection rate of calcification between MG and Target US (P < 0.001), and there was a significant difference in the detection rate of structural distortion between ABUS and MG (P < 0.001). Conclusions Target US, especially ABUS, can significantly improve the sensitivity, specificity and accuracy of the diagnosis of high-risk NMLs in MG. The features of Target US and ABUS such as blood supply, hyperechogenicity, ductal changes, peripheral changes and coronal features could be employed to predict benign and malignant lesions. The coronal features of ABUS were more sensitive than those of Target HHUS in showing structural abnormalities. Target US was less effective than MG in local micro-calcification.

Objective: To compare multiple breast cancer screening methods for evaluating breast non-mass-like lesions (NMLs) and to investigate the best screening method for breast non-mass-like lesions (NMLs). Methods: This retrospective study examined 253 patients aged 24 to 68 years who were diagnosed with breast NMLs from April 2017 to December 2019. All lesions were evaluated by MG, HHUS, and ABUS to determine BI-RADS classification, underwent pathological examination within six months or at least 2 years of follow-up. The sensitivity, specificity, accuracy, positive predictive values (PPV), and negative predictive values (NPV) of MG, HHUS, and ABUS features in the prediction of malignancy were compared. Independent risk factors for malignancy were assessed using non-conditional logistic regression. Results: MG, HHUS, and ABUS findings significantly differed between benign and malignant breast NML, including internal echo, hyperechoic spot, peripheral blood flow, internal blood flow, catheter change, peripheral change, coronal features of ABUS, and structural distortion, asymmetry, and calcification in MG. ABUS was superior to MG and HHUS in sensitivity, specificity, PPV, NPV, as well as in evaluating the necessity of biopsy and accuracy in identifying malignancy. MG was superior to HHUS in specificity, PPV, and accuracy in evaluating the need for biopsy. HHUS was distinctly superior to MG in sensitivity and NPV in determining malignancy; however, specificity, PPV, and accuracy were similar. Moreover, internal blood flow, calcification, and coronal plane feature were independent risk factors in distinguishing benign and malignant lesions. Conclusions: ABUS was superior to HHUS and MG in evaluating the need for biopsy and differentiating benign and malignant in breast NMLs. Compared to each other, HHUS and MG had their own relative advantages. Internal blood flow, calcification, and coronal plane feature were independent risk factors in identifying benign and malignant lesions.