Rachel Frydman Brem MD, Presenter: Board of Directors, iCAD, Inc Board of Directors, Dilon Technologies LLC Stock options, iCAD, Inc Stockholder, Dilon Technologies LLC Consultant, U-Systems, Inc Consultant, Dilon Technologies LLC Consultant, Dune Medical Devices Ltd

Jessica Torrente MD, Abstract Co-Author: Nothing to Disclose

Jocelyn A. Rapelyea MD, Abstract Co-Author: Nothing to Disclose

Caitrin M. Coffey BS, Abstract Co-Author: Nothing to Disclose

Megan R. Kann BA, Abstract Co-Author: Nothing to Disclose

Jennifer H. Lieberman BA, Abstract Co-Author: Nothing to Disclose

Hand held screening breast ultrasound can increase breast cancer detection. However, it requires significant physician time for image acquisition. 3D automated breast ultrasound (ABUS) is being studied for efficient adjunct screening in asymptomatic women with dense breasts. With ABUS, the entirety of the breast is imaged in 3 sections with a 15.4 cm 14-6 mHz linear array transducer .Images are reconstructed coronally and viewed on a dedicated workstation. It is important to identify characteristics of benign lesions imaged with ABUS to minimize recalling patients for additional workup. In our practice we have observed that benign cystic lesions have a characteristic white, echogenic wall (Fig 1). The purpose of this study is to determine how often benign cystic lesions have the “white wall” and to compare that with cancers when imaged with ABUS.

ABUS images of 58 asymptomatic women with 64 sequentially biopsy-proven cysts and 44 women with 48 sequentially biopsy-proven cancers imaged with ABUS were included. None of the lesions which underwent biopsy were simple cysts. Included as cysts were circumscribed lesions identified on 3D ultrasound which resolved upon fine needle aspiration or core biopsy and were pathologically described as “cyst contents”, “benign breast aspirate”, or “fibrocystic changes”. Imaging was reviewed by radiologists experienced with ABUS who designated each cystic lesion and cancerous lesion as positive or negative for an echogenic white wall.

39 of 64 cysts (60.9%) and 0 of 48 cancers (0%) exhibited a white wall (p<0.001). Radiologist A designated 13/23 (56.5%) cysts as having a white wall, Radiologist B 8/15 (53.3%), and Radiologist C 18/26 (69.2%). No cancers exhibited the presence of an echogenic white wall.

An echogenic “white wall” seen in the majority of cysts can likely be a differentiating characteristic of benign lesions and may result in obviating the need to recall patients who have well-circumscribed hypoechoic lesions that do not fulfill the criteria of a simple cyst.

The presence of a “white wall” in a hypoechoic lesion visualized on ABUS is characteristic of a benign lesion, is not seen in cancer and may obviate the need to recall patients for further evaluation.

Brem, R, Torrente, J, Rapelyea, J, Coffey, C, Kann, M, Lieberman, J, Characteristic Appearance of Benign Cysts with 3D Automated Breast Ultrasound (ABUS).  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12030529.html