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. 2020 May;21(5):550-560.
doi: 10.3348/kjr.2019.0525.

Automated Breast Ultrasound: Interobserver Agreement, Diagnostic Value, and Associated Clinical Factors of Coronal-Plane Image Features

Affiliations
Free PMC article

Automated Breast Ultrasound: Interobserver Agreement, Diagnostic Value, and Associated Clinical Factors of Coronal-Plane Image Features

Guoxue Tang et al. Korean J Radiol. .
Free PMC article

Abstract

Objective: To evaluate the interobserver agreement, diagnostic value, and associated clinical factors of automated breast ultrasound (ABUS) coronal features in differentiating breast lesions.

Materials and methods: This study enrolled 457 pathologically confirmed lesions in 387 female (age, 46.4 ± 10.3 years), including 377 masses and 80 non-mass lesions (NMLs). The unique coronal features, including retraction phenomenon, hyper- or hypoechoic rim (continuous or discontinuous), skipping sign, and white wall sign, were defined and recorded. The interobserver agreement on image type and coronal features was evaluated. Furthermore, clinical factors, including the lesion size, distance to the nipple or skin, palpability, and the histological grade were analyzed.

Results: Among the 457 lesions, 296 were malignant and 161 were benign. The overall interobserver agreement for image type and all coronal features was moderate to good. For masses, the retraction phenomenon was significantly associated with malignancies (p < 0.001) and more frequently presented in small and superficial invasive carcinomas with a low histological grade (p = 0.027, 0.002, and < 0.001, respectively). Furthermore, continuous hyper- or hypoechoic rims were predictive of benign masses (p < 0.001), whereas discontinuous rims were predictive of malignancies (p < 0.001). A hyperechoic rim was more commonly detected in masses more distant from the nipple (p = 0.027), and a hypoechoic rim was more frequently found in large superficial masses (p < 0.001 for both). For NMLs, the skipping sign was a predictor of malignancies (p = 0.040).

Conclusion: The coronal plane of ABUS may provide useful diagnostic value for breast lesions.

Keywords: Breast diseases; Breast neoplasms; Diagnostic imaging; Ultrasonography.

Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Retraction phenomenon of invasive ductal carcinoma.
A. Coronal automated breast ultrasound image of 47-year-old woman with impalpable, grade II invasive ductal carcinoma (11-mm deep from skin, 75-mm far from nipple, 11-mm in size) with retraction phenomenon (circle). B. On corresponding pathology slide (hematoxylin-eosin stain, × 10) is central tumor with surrounding spicules pattern. Tumor is surrounded by desmoplastic changes in stroma, which reveals fibrous tissues infiltrating carcinoma cells that has alternately grown up.
Fig. 2
Fig. 2. Retraction phenomenon and skipping sign of sclerosing adenosis.
A. Coronal automated breast ultrasound image of 43-year-old woman with palpable, 6-mm deep from skin, 35-mm far from nipple, 15-mm in size, sclerosing adenosis with retraction phenomenon (circle) and skipping sign (arrows). B. On corresponding pathology slide (hematoxylin-eosin stain, × 10) are increased numbers of glands, some cystic enlarged glands at periphery and centrally located fibrosis.
Fig. 3
Fig. 3. Skipping sign of non-mass lesion.
Coronal (A) and transverse (B) automated breast ultrasound images of 44-year-old woman with impalpable non-mass lesion (5-mm deep from skin, 21-mm far from nipple, 39-mm in size), which displays skipping sign (arrows), and pathological result is grade I invasive ductal carcinoma associated with ductal carcinoma in situ. B. On transverse plane is diffuse hypoechoic area with microcalcifications (arrow).
Fig. 4
Fig. 4. Continuous hyperechoic rim of fibroadenoma.
Coronal (A) and transverse (B) automated breast ultrasound images of 44-year-old woman with impalpable fibroadenoma (36-mm deep from skin, 10-mm far from nipple, 10-mm in size) with continuous hyperechoic rim (circle). B. On transverse plane, above surrounding tissue is pushed by mass (arrows).
Fig. 5
Fig. 5. Discontinuous hyperechoic rim of invasive ductal carcinoma.
Coronal (A) and transverse (B) automated breast ultrasound images of 60-year-old woman with impalpable grade II invasive ductal carcinoma (11-mm deep from skin, 24-mm far from nipple, 13-mm in size) with discontinuous hyperechoic rim (arrows; A). B. On transverse plane, discontinuous rim was caused by infiltration between tumor and surrounding tissue (arrows).
Fig. 6
Fig. 6. Continuous hypoechoic rim of fibroadenoma.
Coronal (A) and transverse (B) automated breast ultrasound images of 34-year-old woman with palpable fibroadenoma (4-mm deep from skin, under nipple, 23-mm in size) with continuous hypoechoic rim (circle). B. On transverse plane, hypoechoic rim was caused by lateral acoustic shadow (arrows).
Fig. 7
Fig. 7. White wall sign of fibroadenoma.
Coronal (A) and transverse (B) automated breast ultrasound images of 35-year-old woman with palpable fibroadenoma (5-mm deep from skin, 58-mm far from nipple, 23-mm in size) with white wall sign (circle). B. On transverse plane, white wall sign was associated with posterior enhancement (arrows).

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