ABUS Could Improve Access to Breast Cancer Screening in Resource-Limited, Underserved Regions

Automated breast ultrasound (ABUS) screening with remote reading met benchmark performance for cancer detection in comparison to mammography, with infrequent interval cancers, according to a study published in the American Journal of Roentgenology (AJR).

“Teleradiology combined with ABUS could help improve access to breast cancer screening services in resource-limited or underserved regions where mammographic screening is not established,” wrote corresponding author Hongping Song, MD, PhD, from the department of ultrasound at Xijing Hospital, Fourth Military Medical University in China.

Dr. Song’s research team included asymptomatic women, 35-69 years old, from 46 community health centers across 18 provinces representing all six regions of China (January-December 2021). Participants underwent screening ABUS as the sole breast cancer screening modality, with images acquired by a technologist at the community health center. Three-dimensional volumetric data were transferred via cloud-based software to a single remote reading center, where examinations were interpreted independently in batches by two subspecialized breast radiologists using BI-RADS; a third radiologist at the remote reader center resolved discrepancies. Diagnostic reports were then returned to the community centers, and patients sought follow-up care at local hospitals. The reference standard incorporated a combination of histopathology and 24-month follow-up. Outcomes measures included cancer detection rate, abnormal interpretation rate (AIR), sensitivity, specificity, biopsy rate, and PPV.

Ultimately, primary screening by ABUS with remote reading detected 24 cancers among 5,978 women (4 per 1,000 women). AIR was 11.9%. PPV of biopsy was 24.0%. And of the 24 ABUS-detected cancers, 95.8% were invasive (median size, 10.0 mm; 73.9% node-negative). Two interval cancers (0.33 per 1000 women) were diagnosed during follow-up.