Evaluating the Role of Automated Breast Ultrasound in Dense Breast Screening

Recent research has explored the potential of automated breast ultrasound (ABUS) as a supplemental screening tool for women with dense breast tissue, a group for whom additional screening beyond mammography is often recommended. Traditional handheld ultrasound, while commonly used, faces challenges such as being operator-dependent and time-intensive.

The study, drawing on data from the Breast Cancer Surveillance Consortium, analyzed more than 25,000 supplemental screening exams performed from 2017 to 2020. This included approximately 4,200 ABUS exams and over 21,000 handheld ultrasound exams. Women aged 40 to 74 with heterogeneously dense or extremely dense breasts, with no personal history of breast cancer, were the focus of this evaluation across 27 U.S. imaging facilities.

Key findings of the study indicated that ABUS had a cancer detection rate of 2.5 per 1,000 exams, compared to 1.7 per 1,000 exams with handheld ultrasound—a difference that was not statistically significant. The positive predictive values for biopsies were also comparable between both modalities.

One significant advantage of ABUS was its lower abnormal interpretation rate or recall rate, recorded at 15% compared to 19% for handheld ultrasound. Moreover, only 3% of women screened with ABUS received a BI-RADS 3 recommendation, whereas 15% did with handheld ultrasound. This suggests that ABUS may result in fewer subsequent appointments and less patient anxiety.

However, it is noteworthy that ABUS led to more initial BI-RADS-0 assessments, prompting evaluations with targeted diagnostic ultrasound where many findings were resolved as benign.

Despite the observational nature of this study, which could introduce selection bias, the results suggest that ABUS holds promise as an effective alternative to handheld ultrasound, with equivalent cancer detection rates but reduced recalls and follow-up recommendations. Nonetheless, the study did not assess the impact of radiologist experience with ABUS, which could have influenced the outcomes.

Overall, while randomized trials could offer more robust evidence, this research provides compelling insight into the practical application of ABUS in real-world clinical settings. The findings conclude that ABUS may enhance screening for women with dense breast tissue, offering a potentially more efficient pathway with fewer unnecessary interventions.

For further reading, the study is detailed in the Journal of the American College of Radiology (Rauscher GH, Alsheik N, Eavey J, et al., 2026).