The potential of adding mammography to HHUS and ABUS to reduce unnecessary biopsies in BI-RADS ultrasound category 4a: a multicenter hospital-based study in China

Abstract

Abstract Purpose This study compares image features influencing false-positive lesions in category 4a between handheld ultrasound (HHUS) and automated breast ultrasound (ABUS) and explores the role of second-look mammography (MAM) adjunct to US of 4a masses. Methods Women aged 30 to 69 underwent HHUS and ABUS from 2016 through 2017 at five high-level hospitals in China with those aged 40 or older also accepting MAM. Logistic regression analysis assessed image variables correlated with false-positive lesions in US category 4a. Unnecessary biopsies, invasive cancer (IC) yields, and diagnostic performance among different biopsy thresholds were compared. Results 1946 women (44.9±9.8 years) were eligible for analysis. 188 (9.66%) were categorized as category 4a in HHUS and 117 (6.01%) of ABUS. Orientation, architectural distortion, and duct change were independent factors associated with the false-positive lesions in 4a of HHUS, whereas premenopausal, size, calcification, and architectural distortion were significant features of ABUS (all P＜0.05). For HHUS, both unnecessary biopsy rate and IC yields were significantly reduced when changing biopsy thresholds by adding MAM for US 4a patients (scenario #1:BI-RADS 3, 4, and 5; scenario #2: BI-RADS 4 and 5) compared with the current scenario (all P＜0.05). However, scenario #1 reduced false-positive biopsies without affecting IC yields when compared to the current scenario for ABUS (P＜0.001; P=0.125). Conclusions The higher unnecessary biopsy rate of category 4a by ABUS was similar to HHUS. However, the second-look MAM adjunct to ABUS has the potential to safely reduce false-positive biopsies.