Differentiation Of Benign And Malignant Breast Lesions:a Comparison Between Automatically Generated Breast Volume Scans And Handheld Ultrasound Examinations

Part I Differentiation of benign and malignant breast lesions:A comparison between automatically generated breast volume scans and handheld ultrasound examinationsObjective:To assess the diagnostic value of automated breast volume scanning (ABVS) or conventional handheld ultrasonography (HHUS) for the differentiation of benign and malignant breast lesions.Materials and methods:The study prospectively evaluated239lesions in213women who were scheduled for open biopsy. The patients underwent ABVS and conventional HHUS. The sensitivity, specificity, accuracy, false positive rate, false negative rate, and positive and negative predictive values for HHUS and ABVS images were calculated using histopathological examination as the gold standard. Additionally, diagnostic accuracy was further evaluated according to the size of the masses.Results:Among the239breast lesions studied, pathology revealed85(35.6%) malignant lesions and154(64.4%) benign lesions. ABVS was similar to HHUS in terms of sensitivity (95.3%vs.90.6%), specificity (80.5%vs.82.5%), accuracy (85.8%vs.85.3%), positive predictive value (73.0%vs.74.0%), and negative predictive value (93.3%vs.94.1%). The area under the receiver operating characteristic (ROC) curve, which is used to estimate the accuracy of the methods, demonstrated only minor differences between HHUS and ABVS (0.928and0.948, respectively).Conclusions:The diagnostic accuracy of HHUS and ABVS in differentiating benign from malignant breast lesions is almost identical. However, ABVS can offer new diagnostic information. ABVS may help to distinguish between real lesions and inhomogeneous areas, find small lesions, and demonstrate the presence of intraductal lesions. This technique is feasible for clinical applications and is a promising new technique in breast imaging. Part II Inter-observer Variability of Sonograms of Breast Lesions Obtained by Automated Breast Volume ScannerOBJECTIVE:To evaluate the interobserver agreement of radiologists in the description and final assessment of breast sonograms obtained using an automated breast volume scanner (ABVS) using a unique descriptor of three-dimensional ultrasound (3D US) and the Breast Imaging Reporting and Data System (BI-RADS) US lexicon.METHODS:From August to December2010,208patients were subjected to an ABVS examination in the supine position, and data were automatically sent to the ABVS workstation. Two radiologists independently evaluated234breast masses (148benign and86malignant masses) using a unique descriptor from the3D US and the BI-RADS US lexicon. The reviewers were blinded to the patient's mammographic images, medical history, and pathologic findings. The interobserver agreement was measured using kappa statistics.RESULTS:Substantial agreement was obtained for lesion shape, orientation, margin, echo pattern, posterior acoustic features, calcification and final assessment (κ=0.79,0.74,0.76,0.69,0.68,0.71and0.70, respectively). Fair agreement was obtained for retraction phenomenon and lesion boundary (κ=0.54and0.42, respectively).CONCLUSIONS:The interobserver agreement for breast sonograms obtained by ABVS is good, especially for lesion shape and margin; however, the interobserver agreement for the retraction phenomenon, which is a unique descriptor of coronal-plane3D US, needs to be improved.