J Breast Cancer.  2016 Dec;19(4):429-437. 10.4048/jbc.2016.19.4.429.

Detectability and Usefulness of Automated Whole Breast Ultrasound in Patients with Suspicious Microcalcifications on Mammography: Comparison with Handheld Breast Ultrasound

• Choi JJ
• Kim SH
• Kang BJ
• Song BJ

• KMID: 2362930
• DOI: http://doi.org/10.4048/jbc.2016.19.4.429

Abstract

PURPOSE
The purpose of this study was to prospectively evaluate the detectability and usefulness of automated whole breast ultrasound (AWUS) and to compare it with handheld breast ultrasound (HHUS) in cases with suspicious microcalcifications identified by mammography.
METHODS
Forty-two patients with 43 suspicious microcalcifications (25 malignant and 18 benign) detected by mammography underwent AWUS, HHUS, and histol-ogic examination. With knowledge of the mammographic findings, HHUS was performed to assess the visibility of the microcalcifications and the presence of associated masses or ductal changes. Two radiologists reviewed the AWUS images in consensus using the same methods employed for HHUS. Detectability of AWUS was compared with that of HHUS and was correlated with histologic and mammographic findings.
RESULTS
Of the 43 lesions, 32 (74.4%) were detectable by AWUS and 31 (72.1%) by HHUS. No significant differences in sensitivity were found between the two methods (p=0.998). AWUS detected 96% (24/25) of malignant microcalcifications and 44.4% (8/18) of benign microcalcifications. AWUS was more successful in the detection of malignant vs. benign lesions (96.0% vs. 44.4%, p=0.002), lesions >10 mm vs. ≤10 mm in size (86.7% [26/30] vs. 46.2% [6/13], p=0.009), lesions with a fine pleomorphic or linear shape vs. a round or amorphous or coarse heterogeneous shape (94.7% [18/19] vs. 58.3% [14/24], p=0.021), and lesions associated with a mass or architectural distortion vs. without obvious changes on mammography (100% [19/19] vs. 54.2% [13/24], p=0.022).
CONCLUSION
Detectability of AWUS was comparable to that of HHUS in cases where suspicious microcalcifications were identified on mammography. Therefore, AWUS might be helpful in the performance of ultrasound-guided percutaneous procedures for highly suspicious microcalcifications.

Keyword

Breast neoplasms; Calcinosis; Mammary glands; Mammography; Ultrasonography

MeSH Terms

Breast Neoplasms
Breast*
Calcinosis
Consensus
Humans
Mammary Glands, Human
Mammography*
Prospective Studies
Ultrasonography*

Figure

• 

  Figure 1 Flow chart shows the study population, inclusion and exclusion criteria, and pathologic findings. Three patients with benign results on biopsy underwent 11-gauge vacuum-assisted biopsy or surgical excision due to patient anxiety. US=ultrasound; HHUS=handheld breast ultrasound; MMG=mammography.

• 

  Figure 2 A 42-year-old woman with fibrocystic disease in the right breast. (A) Spot magnification mammogram shows grouped punctate microcalcifications in inner breast (arrow). (B) Handheld ultrasound (US) shows hyperechoic microcalcifications (arrows). These microcalcifications were not seen by automated whole breast US. This may be due to the lower resolution of automated whole breast US.

• 

  Figure 3 A 49-year-old woman with fibrocystic disease in the left breast. (A) Spot magnification mammogram shows grouped punctate or amorphous microcalcifications in outer breast (arrows). (B) Automated whole breast ultrasound (US) shows hyperechoic microcalcifications within the hypoechoic area (arrows). These microcalcifications were not detected by handheld US. This may be due to the operator dependency of handheld breast US.

• 

  Figure 4 A 58-year-old woman with ductal carcinoma in situ in the right breast. (A, B) Craniocaudal and mediolateral oblique views of mammogram shows fine pleomorphic microcalcifications in deep central breast (arrows). (C) Axial T1-weighted contrast-enhanced magnetic resonance image shows an irregular enhancing mass in central posterior portion of right breast (arrow). These microcalcifications were not seen by hand held ultrasound (US) and automated whole breast US.

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  Figure 5 A 43-year-old woman with ductal carcinoma in situ in the left breast. (A) Craniocaudal view of mammogram shows segmental fine pleomorphic microcalcifications in central (arrowhead) and peripheral outer breast (arrow). (B, C) Handheld ultrasound (US) shows an intraductal hypoechoic mass with microcalcifications (arrowheads), which matched with central microcalcifications on mammogram. (D) Automated whole breast US shows segmental ductal dilatation with intraductal microcalcifications (arrowhead), which matched with central microcalcifications on mammogram. Grouped microcalcifications (arrow) in peripheral breast are found, which matched with peripheral microcalcifications on mammogram.

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