jksr Journal of the Korean Society of Radiology J Korean Soc Radiol 1738-2637 2288-2928 The Korean Society of Radiology 10.3348/jksr.2019.80.1.32 jksr-80-32 Review Article Clinical Applications of Automated Breast Ultrasound: Screening for Breast Cancer KimSun MiMD YunBo LaMD JangMijungMD ∗ Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea Corresponding author Mijung Jang, MD Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, Korea. Tel 82-31-787-7622 Fax 82-31-787-7614 E-mail mjjang74@gmail.com 01 2019 20 01 2019 80 1 32 46 20112018 12012019 16012019 Copyright © 2019 The Korean Society of Radiology 2019 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract

Automated breast ultrasonography (ABUS) is a recently introduced technology. Similar to handheld ultrasound (HHUS), it is a supplementary screening test for breast cancer to be used along with mammography. It is particularly useful for detecting invasive breast cancers that may be overlooked by mammography in denser breast tissue. The use of ABUS is becomingmore common because of the advantages of low operator dependency during image acquisition, high reproducibility, a wide field-of-view, and unavailability of better coronal imaging with HHUS. Consequently, there have been suggestions to extend ABUS use to diagnostic screening. Therefore, in this paper, we provide a review of the literature and discuss the usefulness and value of ABUS in breast cancer screening.

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An overview of the ABUS system. The ABUS system with a prone method scanner (A) can fully scan each breast in 30 seconds. A 92-mm linear ultrasound probe automatically rotates around the nipple in a cone-shaped scan as the patient lies on the scanning bed. The review workstation displays multiplane images, including 2D axial and sagittal views, as well as 3D images (B) (images obtained from the Hitachi website). The ABUS system with a supine method scanner (C) scans the entire breast volume on medial, anteroposterior, and lateral views. Each examination, including both breasts, takes approximately 15 minutes. The gentle shape of the Reverse Curve™ (InveniaTM ABUS, Automated Breast Ultrasound System; GE Healthcare, Sunnyvale, CA, USA) transducer (D) follows the natural contour of the breast, providing patient comfort, full contact, and comprehensivecoverage. The 15-cm field-of-view transducer is easy to position and maintains even compression while scanning. ABUS = automated breast ultrasonography

Screening results from a 55-year-old woman. ABUS is used to screen mammographically dense breast tissue. Axial (A), sagittal (B), and coronal (C) ABUS views show a spiculated, irregular, hypoechoic mass (arrows) with shadowing at the three o'clock position in the left breast. A handheld ultrasound examination of the biopsied specimen (D) shows similar features of the mass (arrows), which was confirmed as invasive ductal cancer [pT1cN0(sn)]. ABUS = automated breast ultrasonography

A 53-year-old woman with invasive ductal cancer. Diagnostic ABUS was performed for a recently confirmed invasive ductal cancer. The coronal ABUS image (A) shows multifocal and multicentric cancers in the right breast, identical to those on the maximum intensity projection image of post-gadolinium-enhanced breast MRI (B). ABUS = automated breast ultrasonography

Follow-up of a 42-year-old woman with multiple probably benign masses. A side-by-side comparison with an ultrasound image taken six months previously. The mass (arrows) shows no significant change compared to the previous image (arrowheads).

A 43-year-old woman with invasive ductal cancer. Diagnostic ABUS was performed for a recently confirmed invasive ductal cancer. An axial ABUS image (A) shows a microlobulated, irregular, hypoechoic mass (arrows) at the 9 o'clock position in the right breast, (B) a preoperative MR examination identified another mass (arrow) in the upper quadrant of the right breast on a computer-aided diagnosis maximum intensity projection image of post-gadolinium-enhanced breast MRI (B). A reinterpreted ABUS image (C) shows a 0.5-cm indistinct, oval, hypoechoic mass (arrows), confirmed as another focus of invasive ductal cancer. ABUS = automated breast ultrasonography

A 67-year-old woman with DCIS. Diagnostic ABUS was performed for a recently confirmed DCIS. An axial ABUS image (A) shows an indistinct, oval, heterogeneous echoic mass (arrows) in the subareolar area of the right breast. Right craniocaudal mammography (B) shows an indistinct, irregular, high-density mass with internal microcalcifications (arrows). Handheld ultrasound-assisted localization (C) shows microcalcifications in an isoechoic mass (arrows), which is difficult to recognize without correlation with mammography. Post-localization mammography (D) confirmed ultrasonographic calcifications correlated with a mammographic lesion (arrows). ABUS = automated breast ultrasonography, DCIS = ductal carcinoma in situ

A 63-year-old woman with left nipple discharge. Diagnostic ABUS was performed for left nipple discharge. An axial ABUS image (A) shows an indistinct, oval, isoechoic solid and cystic mass (arrows) in the subareolar area of the left breast. The mass (arrows) is identical to that obtained using handheld ultrasound examination (B); however, the subareolar lesion is not commonly missed by ABUS due to nipple shadowing and therefore requires careful evaluation. ABUS = automated breast ultrasonography

Screening of a 59-year-old woman. ABUS was performed to screen dense breasts. An axial ABUS image (A) shows an indistinct, irregular, hypoechoic mass (arrows) in the upper outer quadrant of the left breast, which was not detected by a handheld ultrasound examination (B). This case was recalled due to a posterior shadowing artifact. ABUS = automated breast ultrasonography