Ellen Bachman Mendelson MD, Presenter: Research support, Siemens AG Speakers Bureau, Siemens AG Medical Advisory Board, Quantason, LLC Consultant, Quantason, LLC

Marcela Bohm-Velez MD, Abstract Co-Author: Consultant, Koninklijke Philips NV Consultant, Matakina Technology Limited

Thomas S. Chang MD, Abstract Co-Author: Nothing to Disclose

Mariana Solari-Font MD, Abstract Co-Author: Nothing to Disclose

Sandra Sheila Rao MD, Abstract Co-Author: Nothing to Disclose

Erin Irene Neuschler MD, Abstract Co-Author: Nothing to Disclose

Barbara H. Ward MD, Abstract Co-Author: Nothing to Disclose

Judith A. Wolfman MD, Abstract Co-Author: Nothing to Disclose

Michelle Renee Straka MD, Abstract Co-Author: Nothing to Disclose

Andy Milkowski MS, Abstract Co-Author: Employee, Siemens AG

Maria Kalata, Abstract Co-Author: Nothing to Disclose

Ingolf Karst MD, Abstract Co-Author: Nothing to Disclose

Mickey Woodard RT, Abstract Co-Author: Nothing to Disclose

To study equivalence in lesion detection & assessment between HHUS and whole breast AUS, independently interpreted.

From 4/2012 to 2/2014, 505 pts. referred for breast US exams at 2 sites participated in this IRB-approved, HIPAA-compliant prospective study. Physicians performed HHUS with a 18-6 MHz linear transducer using ACRIN 6666 documentation & assigning BI-RADS per lesion of 2 to 6, 1 (normal), or 0 (not seen) when HHUS and AUS were compared. For AUS, a sonographer positioned a wide 14-5MHz transducer for AP, lateral, and medial views. Transverse, coronal, and sagittal views were reviewed at a workstation by a 2nd breast imager blinded to HHUS. AUS and HHUS exams were integrated with clinical, mammography & MRI data. Where AUS and HHUS BI-RADS were different, clinical significance was determined and explanation sought.

Age range: 19-92y. 505 pts. had 745 lesions. 87/505(17 %) had different HHUS and AUS lesion BI-RADS. Mismatches were HHUS 0 (not seen) or 1 (negative) and AUS 4 (suspicious) in 29/87(33%); BI-RADS 2 on HHUS & 4 on AUS in 16/87(18%); and 4 on HHUS with 0,1, or 2 on AUS in 26/87(30%). No BI-RADS mismatch resulted in cancer diagnosis. All lesions biopsied were benign. For BI-RADS HHUS 0/1 & AUS 4, many 4’s had hypoechoic shadowing artifacts seen on one AUS view, often the lateral. Where HHUS was BI-RADS 2 and AUS 4, oval masses <8mm had indistinct margins on the coronal & transverse views. Most HHUS lesions not seen on AUS were found retrospectively on transverse but not coronal view.

HHUS & AUS lesion BI-RADS assessments differed in 18%, but no cancers were miscast as benign. For AUS success in breast imaging workflow, interpreters may benefit from knowing the AUS appearance of artifacts as well as lesions studied with HHUS.

With concern for masking of cancers by dense breast tissue on mammography, a supine automated breast US scanner has been approved by the FDA for supplemental screening, only one of many indications for breast ultrasound. With experience in the similarities and differences between small FOV HHUS and AUS, automated scanners can be useful for diagnostic applications such as detection and follow-up of multiple benign-appearing masses.

Mendelson, E, Bohm-Velez, M, Chang, T, Solari-Font, M, Rao, S, Neuschler, E, Ward, B, Wolfman, J, Straka, M, Milkowski, A, Kalata, M, Karst, I, Woodard, M, BI-RADS Differences in Lesion Assessment between Handheld Physician-Performed Whole Breast Ultrasound (HHUS) and Supine Automated Ultrasound (AUS).  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14012093.html