Comparison of diagnostic efficacy of 2D and 3D ultrasound in women under the age of mammography screening

Breast cancer is the most common cancer among women worldwide. Younger women are more likely than older women to have aggressive molecular subtypes and late-stage disease. Mammography has less sensitivity in detecting breast cancer in women with a dense breast, and 2D ultrasound (2D US) has limitations, such as the specialists high level of skill and experience and the time it takes to perform the examination. Nowadays, there is a new technique – automated volumetric ultrasound scanning of the breast (3D US), which allows you to obtain high-resolution images.

Aim. To perform a comparative analysis of the diagnostic efficacy of 2D US and 3D US among women under 40 years of age with high breast tissue density.

Methods. A retro-prospective clinical single-center study. From February 2019 to May 2023, 1511 patients under the age of 40 were examined. The patients were divided into two groups. Patients in group A underwent 2D ultrasound, the results of the study were evaluated according to the BI-RADS classification. In addition to 2D ultrasound, the patients who were placed in group B underwent 3D US also with the BI-RADS category. Based on the results of the study, the positive and negative predictive value, sensitivity, specificity and accuracy, as well as the compilation of a predictive model of the method were determined.

Results. The 2D US in group A showed sensitivity of 0.8, specificity 1, balanced accuracy of 0.9, and area under the predictive model curve of 0.947, US in group B 0.89, 0.98, 0.94, and 0.903, respectively, and US of the entire sample of 0.87, 0.99, 0.93, and 0.916, respectively. The 3D US in group B showed a sensitivity of 0.95, specificity of 0.99 and a balanced accuracy of 0.97 and an area under the predictive model curve of 0.968.

Conclusion. The diagnostic efficiency of 3D US of the mammary glands in patients under 40 years of age is comparable in terms of specificity and is better in terms of accuracy, sensitivity and a better prognostic model of the method compared to US examination in 2D mode. The 3D US method has advantages in comparison with 2D US examination, namely reproducibility, operator independence of the method, reduced examination time, obtaining visualization of the entire organ, improved visualization in multicentric and multifocal processes, the possibility of operational planning, the possibility of “double reading” of the results.

1. Shapira N. The potential contribution of dietary factors to breast cancer prevention. Eur. J. Cancer Prevent. 2017; 26 (5): 385–395. http://doi.org/10.1097/cej.0000000000000406

2. Global Burden of Disease 2019 Cancer Collaboration; Kocarnik J.M., Compton K., Dean F.E. et al. Cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life years for 29 cancer groups from 2010 to 2019: a systematic analysis for the global burden of disease study 2019. JAMA Oncol. 2022; 8 (3): 420–444. http://doi.org/10.1001/jamaoncol.2021.6987

3. Merabishvili V.M., Semiglazov V.F., Komiakhov A.V. et al. The state of cancer care in Russia: breast cancer. Epidemiology and survival of patients. The impact of the SARS-CoV-2-beta-coronavirus epidemic (clinical and population study). Tumors of Female Reproductive System. 2023; 19 (3): 16–24. https://orcid.org/10.17650/1994-4098-2023-19-3-16-24 (In Russian)

4. Merabishvili V.M. The state of cancer care In Russia: breast cancer among the male population. Prevalence and survival of patients (Population study at the federal district level). Voprosy Onkologii. 2022; 68 (3): 303–312. https://doi.org/10.37469/0507-3758-2022-68-3-286-293 (In Russian)

5. Cathcart-Rake E.J., Ruddy K.J., Bleyer A., Johnson R.H. Breast Cancer in Adolescent and Young Adult Women Under the Age of 40 Years. JCO Oncol. Pract. 2021; 17 (6): 305–313. http://doi.org/10.1200/op.20.00793

6. Desreux J.A.C. Breast cancer screening in young women. Eur. J. Obstet. Gynecol. Reprod. Biol. 2018; 230: 208–211. http://doi.org/10.1016/j.ejogrb.2018.05.018

7. Nazari S.S., Mukherjee P. An overview of mammographic density and its association with breast cancer. Breast Cancer. 2018; 25 (3): 259–267. http://doi.org/10.1007/s12282-018-0857-5

8. Scheel J.R., Lee J.M., Sprague B.L. et al. Screening ultrasound as an adjunct to mammography in women with mammographically dense breasts. Am. J. Obstet. Gynecol. 2015; 212 (1): 9–17. http://doi.org/10.1016/j.ajog.2014.06.048

9. Jorgensen K.J., Zahl P.-H., Gotzsche P.C. Breast cancer mortality in organised mammography screening in Denmark: comparative study. BMJ. 2010; 340 (mar. 23, 1): c1241–c1241. http://doi.org/10.1136/bmj.c1241

10. Rebolj M., Assi V., Brentnall A. et al. Addition of ultrasound to mammography in the case of dense breast tissue: systematic review and meta-analysis. Br. J. Cancer. 2018; 118 (12): 1559–1570. http://doi.org/10.1038/s41416-018-0080-3

11. Vourtsis A., Kachulis A. The performance of 3D ABUS versus HHUS in the visualisation and BI-RADS characterisation of breast lesions in a large cohort of 1,886 women. Eur. Radiol. 2017; 28 (2): 592–601. http://doi.org/10.1007/s00330-017-5011-9

12. Xin Y., Zhang X., Yang Y. et al. A multicenter, hospital-based and non-inferiority study for diagnostic efficacy of automated whole breast ultrasound for breast cancer in China. Sci. Reports. 2021; 11 (1): 13902. http://doi.org/10.1038/s41598-021-93350-1

13. Monticciolo D.L., Newell M.S., Moy L. et al. Breast Cancer Screening in Women at Higher-Than-Average Risk: Recommendations From the ACR. J. Am. Coll. Radiol. 2018; 15 (3): 408–414. http://doi.org/10.1016/j.jacr.2017.11.034

14. Lin X., Wang J., Han F. et al. Analysis of eighty-one cases with breast lesions using automated breast volume scanner and comparison with handheld ultrasound. Eur. J. Radiol. 2012; 81 (5): 873–878. http://doi.org/10.1016/j.ejrad.2011.02.038

15. Wang H.Y., Jiang Y.X., Zhu Q.L. et al. Differentiation of benign and malignant breast lesions: A comparison between automatically generated breast volume scans and handheld ultrasound examinations. Eur. J. Radiol. 2012; 81 (11): 3190–3200. http://doi.org/10.1016/j.ejrad.2012.01.034

16. Kotsianos-Hermle D., Wirth S., Fischer T. et al. First clinical use of a standardized three-dimensional ultrasound for breast imaging. Eur. J. Radiol. 2009; 71 (1): 102–108. http://doi.org/10.1016/j.ejrad.2008.04.002

17. Kim S.H., Kang B.J., Choi B.G. et al. Radiologists’ Performance for Detecting Lesions and the Interobserver Variability of Automated Whole Breast Ultrasound. Korean J. Radiol. 2013; 14 (2): 154. http://doi.org/10.3348/kjr.2013.14.2.154

18. Prosch H., Halbwachs C., Strobl C. et al. Automatisierter Brustultraschall vs. handgeführter Brustultraschall: BI-RADS-Einstufung, Untersuchungsdauer und Erlebnisqualität der Untersuchung. Ultraschall Med. – Eur. J. Ultrasound. 2011; 32 (05): 504–510. http://doi.org/10.1055/s-0031-1273414

19. Skaane P., Gullien R., Eben E.B. et al. Interpretation of automated breast ultrasound (ABUS) with and without knowledge of mammography: a reader performance study. Acta Radiol. 2015; 56 (4): 404–412. http://doi.org/10.1177/0284185114528835

20. Chen L., Chen Y., Diao X.H. et al. Comparative Study of Automated Breast 3-D Ultrasound and Handheld B-Mode Ultrasound for Differentiation of Benign and Malignant Breast Masses. Ultrasound Med. Biol. 2013; 39 (10): 1735–1742. http://doi.org/10.1016/j.ultrasmedbio.2013.04.003

21. Lin X., Jia M., Zhou X. et al. The diagnostic performance of automated versus handheld breast ultrasound and mammography in symptomatic outpatient women: a multicenter, cross-sectional study in China. Eur. Radiol. 2020; 31 (2): 947–957. http://doi.org/10.1007/s00330-020-07197-7