Breast Mass Characterization Using 3‐Dimensional Automated Ultrasound as an Adjunct to Digital Breast Tomosynthesis

Abstract

Objective To retrospectively evaluate the effect of 3D automated ultrasound (3D-AUS) as an adjunct to digital breast tomosynthesis (DBT) on radiologists’ performance and confidence in discriminating malignant and benign breast masses. Methods Two-view DBT (CC and MLO or Lateral) and single-view 3D-AUS were acquired on 51 patients with (subsequently) biopsy-proven masses (13 malignant, 38 benign). Six experienced radiologists rated, on a 13-point scale, the likelihood of malignancy of an identified mass, first by reading the DBT alone, followed immediately by reading the DBT with automatically co-registered 3D-AUS. The diagnostic performance of each method was measured using ROC analysis. and changes in sensitivity and specificity with the McNemar test. After each reading, radiologists took a survey to rate their confidence level in using DBT alone vs combined DBT/3D-AUS as potential screening modalities. Results The six radiologists had an average area under the ROC curve of 0.92 for both modalities (range 0.89–0.97 for DBT, 0.90–0.94 for DBT/3D-AUS). With BI-RADS rating of 4 as the threshold for biopsy recommendation, the average sensitivity of the radiologists increased from 96% to 100% (p>0.08) with 3D-AUS, while the specificity decreased from 33% to 25% (p>0.28). Survey responses indicated an increased confidence in potentially using DBT for screening when 3D-AUS was added (p<0.05 for each reader). Conclusions In this initial reader study, no significant difference in ROC performance was found with the addition of 3D-AUS to DBT. However, a trend to an improved discrimination of malignancy was observed when adding 3D-AUS. Radiologists’ confidence also improved with DBT/3DAUS compared to DBT alone.

Digital Breast Tomosynthesis: State of the Art

“…Development of a compression paddle compatible for both x-ray and US imaging (152), selection of US coupling media, and breast coverage with US particularly at the breast periphery that is not in contact with the compression paddle have been reported (153). In an analysis of 51 patients with masses (13 malignancies), Padilla et al (154) reported similar AUCs for DBT alone and the combined DBT and automated breast US, and an improvement in discriminating masses from simple cysts.…”

Advances in managing breast cancer: a clinical update

“…Three-dimensional automated breast ultrasound has been developed to eliminate inter-performer variability and also to optimize workflow, since the exams are time consuming. CAD for 3D automated breast ultrasound is also in development [9]. Contrast enhanced ultrasound is currently being investigated to potentially assist in increasing sensitivity and specificity [10].…”

Testing a dual-modality system that combines full-field digital mammography and automated breast ultrasound

“…In design two, researchers from the University of Michigan and GE Healthcare have essentially adapted design one and added digital breast tomosynthesis (DBT), a technology that enables 3D images of the breast to be reconstructed [20 – 24]. In a study of 51 patients with biopsy-proven masses, Padilla et al [25] found no significant difference in receiver operating characteristic (ROC) performance when ABUS was added to DBT.…”