The aim of this work is to study the added value of ABUS in the screening of women with suspected breast masses compared to conventional mammography and hand-held ultrasound.
The study included 200 female patients during the period from February 2017 to January 2018.
Inclusion criteria were any female in the child-bearing age complaining of breast pain or lump and those with a positive family history of breast cancer. Exclusion criteria included patients with a known diagnosis of breast cancer under treatment and those with history of mastectomy or previous interventions for breast lesions.
All patients were subjected to a full clinical examination, 80 patients had biopsy and histopathological analysis based on imaging findings.
Routine screening mammography using craniocaudal and mediolateral oblique views for both breasts was performed in 108 patients as those below the age of 30 were screened by ultrasound only as recommended by the international guidelines . Mammography was performed using Senographe Essential (GE Healthcare, USA) full-field digital mammography (FFDM) machine. Mammograms were reviewed for the breast density, presence of masses with detailed analysis of its site, type, number, border, calcifications, and size.
All 200 patients had a hand-held (conventional) ultrasound (HHUS) scan and automated breast ultrasound (ABUS) for both breasts. Hand-held ultrasound was performed on a Toshiba Nemio XG Ultrasound machine (Toshiba Medical Systems, Japan) using a 7–11 MHz linear transducer. The technique performed for HHUS was done after exposure of the breasts with the patient lying supine and her ipsilateral hand raised above the head. The ultrasound probe was oriented perpendicular to the chest wall. Radial scanning technique, in a clockwise fashion, using the nipple as a center point was followed. Scanning of each breast quadrant in the sagittal and transverse planes was also performed and the examination time took about 20 min.
Automated breast ultrasound (ABUS) was performed using the Invenia ABUS machine (GE Healthcare, USA) which is equipped with 14 MHz linear transducer. The scan was performed with the patient in a supine position, a wedge is placed under the back of the patient on the side to be examined; this allows for flattening the breast for improved contact with the probe. After exposure of the breast, application of an adequate amount of coupling gel over the entire surface of the breast is done with an extra amount applied to the nipple-areolar complex to insure proper scanning and avoid scanning artifacts. The transducer was applied to the breast using mild compression to avoid motion artifacts. Scanning was performed in three standard views (coronal, longitudinal, and transverse views) to allow for adequate coverage of the entire breast tissue. Using the nipple as a centering point, the anteroposterior (AP) position is first taken. Lateral position is taken by angling the probe from the axilla towards the sternum and for medial position the probe is angled from the sternum towards the axilla. The scans are initially reviewed on the machine monitor for quality assurance of the acquired scan. The scan time for each acquisition was 1 min and volumetric data obtained were automatically transferred to the Invenia ABUS workstation for post processing including axial, coronal, and sagittal reformats and analysis. The entire examination time was approximately 15 min for both sides.
Ultrasound studies were reviewed for the presence or absence of lesions, location, size, number, outline and contour (regular or irregular), margin or borders (micro or macro lobulations), echogenicity compared to the breast fat, and internal echopattern (homogenous or heterogeneous)
The study researchers reviewed the mammograms, conventional ultrasound, and ABUS findings in conjunction since it was their initial experience with ABUS. The researchers had a combined 10 years experience in breast imaging in between them.