Enhanced Detection of Suspicious Breast Lesions: A Comparative Study of Full-Field Digital Mammography and Automated Breast Ultrasound in 117 Patients with Core Needle Biopsy

Abstract

BACKGROUND This retrospective study from a single center aimed to compare the performance of full-field digital mammography (FFDM) vs automated breast ultrasound (ABUS) in the identification and characterization of suspicious breast lesions in 117 patients who underwent core-needle biopsy (CNB) of the breast. MATERIAL AND METHODS The study involved a group of 301 women. Every patient underwent FFDM followed by ABUS, which were assessed in concordance with BI-RADS (Breast Imaging Reporting and Data System) classification. RESULTS No focal lesions were found in 168 patients. In 133 patients, 117 histopathologically verified focal lesions were found. Among them, 78% appeared to be malignant and 22% benign. ABUS detected 246 focal lesions, including 115 classified as BI-RADS 4 or 5 and submitted to verification, while FFDM revealed 122 lesions, including 75 submitted to verification. The analysis revealed that combined application of both methods caused sensitivity to increase to 100, and improved accuracy improvement. Margin assessments in these examinations are consistent (P<0.00), the lesion's margin type with both methods depends on its malignant or benign character (P<0.03), lesion margins distribution on ABUS depends on estrogen receptor presence (P=0.033), and there was significant correlation between malignant character of the lesion and retraction phenomenon sign (P=0.033). ABUS obtained higher compliance between the size of the lesion in histopathology compared to FFDM (P>0.05). CONCLUSIONS The results shows that ABUS is comparable to FFDM, and even outperforms it in a few of the analyzed categories, suggesting that the combination of these 2 methods may have an important role in breast cancer detection.

Figure 1

FFDM (full-filled digital mammography) of a patient with dense, glandular breast type. No evident lesion is seen.

Figure 2

ABUS (automated breast ultrasound) scan of patient from Figure 1. Right breast in axial, sagittal, and coronal views. An ill-defined, hypoechogenic mass is visible at 9 o’clock. After core-needle biopsy, a lobular carcinoma was diagnosed.

Figure 3

Image of focal lesion’s margin on ABUS and FFDM depending on its type. Figure A shows ABUS image and C shows FFDM image of the same malignant lesion with ill-defined margin. Figure B shows ABUS image of benign lesion with well-defined margin. Figure B shows ABUS image and Figure D shows FFDM image of the same benign lesion with well-defined margin.

Figure 4

Examples of histopathology specimens at 10× magnification. Figure A shows fibroadenoma. Figure B shows ADH. Figure C shows DCIS G2. Figure D shows NST cancer G1.

Figure 5

(A, B) Correlation between focal lesion’s margin on ABUS and FFDM and its grade.

Figure 6

(A, B) Correlation between focal lesion’s margin on ABUS and FFDM and invasive cancer’s character.

Figure 7

Distribution of correlation between focal lesion margin and estrogen receptor expression level on ABUS, p=0.033.

Figure 8

Presence of the retraction phenomenon on ABUS in benign and malignant lesions.

Figure 9

(A, B) Frequency of microcalcifications presence on ABUS and FFDM in lesions diagnosed histopathologically as DCIS (ductal carcinoma in situ) and LCIS (lobular carcinoma in situ).

Figure 10

ABUS, FFDM, and combined ABUS and FFDM ROC curves.