Handheld breast ultrasound bests automation in 2nd-look lesion detection
Handheld ultrasound may be the superior technique for taking a second look at lesions identified on breast MRI.
According to new research published recently in Academic Radiology, handheld ultrasound outperforms automated breast ultrasound in second-look ultrasound evaluations, detecting significantly more lesions in comparison to the latter. The findings contradict research on automatic approaches, much of which has portrayed the technique as equal or superior to handheld alternatives in certain scenarios, such as cases of architectural distortion. There is very little research, however, comparing the two methods in second-look settings despite the fact that these exams are routinely utilized in women’s health.
“There is limited data and no consensus on this topic in literature,” Ulku Tuba Parlakkilic, MD, with the Senology Research Institute in Istanbul, and colleagues noted.
To help fill this gap, the team conducted a prospective analysis on the cases of 54 patients with 66 MRI-detected breast lesions. Each patient was referred for MRI-guided biopsy but underwent both handheld and automated ultrasound prior to the procedure. Researchers compared the accuracy, sensitivity and positive predictive value of each to determine if one technique was more beneficial.
Using handheld ultrasound, 56 of the 66 lesions (84.9%) were identified, while 46 of 66 (69.7%) were detected via the automated approach. Just 2 of 13 of the lesions detected by handheld ultrasound alone were malignant, compared to 2 out of 3 spotted via automation alone. Sensitivity was similar for both techniques, but automated ultrasound achieved greater positive predictive value (by 7%). The team did not note any significant variances in detection based on lesion size, depth, lesion type (mass/non-mass), lesion localization, parenchymal density, kinetic features or morphological findings.
“We think that although a higher PPV is advantageous in the screening setting, it is not an advantage in the second look [ultrasound] setting, because not finding a lesion with [automated breast ultrasound] would lead to an MRI-guided biopsy,” the team explained. “We cannot omit a biopsy due to a negative ABUS examination, as it can have false negative results.”
The group acknowledged that both modalities come with caveats. Though handheld ultrasound was the superior technique in their study, the authors cautioned that its utility is highly dependent on the operator and typically has low reproducibility. Automated ultrasound overcomes both of these limitations.
“Our findings indicate that [both methods] are complementary rather than substitutive modalities, and their combined use may optimize second-look breast imaging,” the authors suggested. “Moreover, we think that [automated breast ultrasound] will and can be very helpful for radiologists with limited experience in second look US evaluation of the breast.”
Read more here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.