Automated breast ultrasound: same detection as handheld, far fewer short-interval recalls

Design

Observational registry study, 27 facilities

Population

25,328 supplemental ultrasound exams in women with dense breasts

Primary outcome

Recall, follow-up, biopsy and cancer detection rates

Effect

Short-interval follow-up 3.0% vs 14.6%; abnormal interpretation 14.9% vs 19.2%

Supplemental ultrasound is increasingly used for women with dense breasts. Automated breast ultrasound (ABUS) promises less operator dependence than handheld scanning. This observational study, published in July, compared 21,110 handheld and 4,218 automated examinations performed from 2017 to 2020 at 27 facilities in three Breast Cancer Surveillance Consortium registries.

ABUS was associated with a lower abnormal interpretation rate (14.9% vs 19.2%) and a much lower short-interval follow-up rate (3.0% vs 14.6%). False-positive initial assessments were also lower. Biopsy recommendation rates, positive predictive values and cancer detection rates showed no apparent difference.

The data are observational, and facilities that adopted ABUS may differ in their readers and populations from those using handheld scanning.

For services offering supplemental ultrasound, ABUS looks like a reasonable way to reduce short-interval recalls without losing detection. Where handheld scanning is used, audit the short-interval follow-up rate, as a high rate adds anxiety and workload without clear gain.

• ABUS was associated with short-interval follow-up in 3.0% against 14.6% for handheld ultrasound.
• Cancer detection rates showed no apparent difference between techniques.
• Abnormal interpretation rates were lower with ABUS (14.9% vs 19.2%).
• Audit your own short-interval follow-up rate on supplemental ultrasound.
• Consider ABUS where operator-dependent handheld scanning limits capacity or consistency.

Why it matters

Short-interval follow-up is the main harm of supplemental ultrasound, and the choice of technique seems to drive much of it.

Don't overread it

This is an observational registry comparison, so facility and reader differences may explain part of the gap.

The statistics, in plain English

The short-interval follow-up difference (3.0% vs 14.6%) is large and statistically clear. 'No apparent difference' in cancer detection means the study did not show a gap, not that it proved the techniques identical.

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