Dependability of Automated Breast Ultrasound (ABUS) in Assessing Breast Imaging Reporting and Data System (BI-RADS) Category and Size of Malignant Breast Lesions Compared with Handheld Ultrasound (HHUS) and Mammography (MG)

He Chen,1 Ming Han,2 Hui Jing,1 Zhao Liu,1 Haitao Shang,1 Qiucheng Wang,1 Wen Cheng1 1Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin City, Heilongjiang Province, People’s Republic of China; 2Department of General Surgery, Heji Hospital of Changzhi Medical College, Changzhi City, Shanxi Province, People’s Republic of ChinaCorrespondence: Wen Cheng; Qiucheng WangDepartment of Ultrasound, Harbin Medical University Cancer Hospital, No. 150, Haping Road, Nangang District, Harbin City, 150081, Heilongjiang Province, People’s Republic of ChinaTel +86 13313677182; +86 13836134350Fax +86 45185718392Email hrbchengwen@163.com; haerbincss@126.comPurpose: This study aimed to evaluate the dependability of automated breast ultrasound (ABUS) compared with handheld ultrasound (HHUS) and mammography (MG) on the Breast Imaging Reporting and Data System (BI-RADS) category and size assessment of malignant breast lesions.Patients and Methods: A total of 344 confirmed malignant lesions were recruited. All participants underwent MG, HHUS, and ABUS examinations. Agreements on the BI-RADS category were evaluated. Lesion size assessed using the three methods was compared with the size of the pathological result as the control. Regarding the four major molecular subtypes, correlation coefficients between size on imaging and pathology were also evaluated.Results: The agreement between ABUS and HHUS on the BI-RADS category was 86.63% (kappa = 0.77), whereas it was 32.22% (kappa = 0.10) between ABUS and MG. Imaging lesion size compared to pathologic lesion size was assessed correctly in 36.92%/52.91% (ABUS), 33.14%/48.84% (HHUS) and 33.44%/43.87% (MG), with the threshold of 3 mm/5 mm, respectively. The correlation coefficient of size of ABUS-Pathology (0.75, Spearman) was statistically higher than that of the MG-Pathology (0.58, Spearman) with P < 0.01, but not different from that of the HHUS-Pathology (0.74, Spearman) with P > 0.05. The correlation coefficient of ABUS-Pathology was statistically higher than that of MG-Pathology in the triple-negative subtype, luminal B subtype, and luminal A subtype (P< 0.01).Conclusion: The agreement between ABUS and HHUS in the BI-RADS category was good, whereas that between ABUS and MG was poor. ABUS and HHUS allowed a more accurate assessment of malignant tumor size compared to MG.Keywords: automated breast ultrasound, hand-held ultrasound, mammography, breast imaging reporting and data system category, size assessment