Automated Whole Breast Ultrasound

What Is Automated Whole Breast Ultrasound?

Automated whole breast ultrasound (AWBU) is an advanced imaging method used for early cancer detection in women with dense breast tissue. A machine is used in AWBU to automatically scan the entire breast, unlike regular ultrasonography, which is usually performed manually by a technician. In women with dense breasts, where mammography may be less successful, it helps detect tumors or abnormalities that may not be seen on normal mammograms by providing a thorough, three-dimensional image of the breast tissue.

AWBU is often used in conjunction with mammography as an additional screening tool for early detection, particularly in high-risk individuals. It is often well tolerated, noninvasive, and radiation-free.

Why Is Automated Whole Breast Ultrasound Needed?

Some women have dense breasts. Dense breast basically means there's more dense tissue inside. The problem with denser breast tissue is that, on a mammogram (an X-ray of the breast), dense tissue and tumors both appear white, making it really hard to differentiate between them. Because of this, a regular mammogram might fail or miss something important.

Now, here, the automated whole-breast ultrasound (ABUS) comes to the rescue. Instead of X-rays, ABUS uses sound waves. These waves can see through dense tissue much better. This provides clearer images of the whole breast, making it easier to spot and understand anything unusual early on.

ABUS provides benefits to women who have very dense breasts (density score 3 or 4). It does not replace a mammogram; it works alongside it to detect cancers that a mammogram might miss.

How Does the Automated Whole Breast Ultrasound (ABUS) Work?

Let me explain, in simple terms, how automated whole-breast ultrasound works.

High-frequency sound waves are used in automated whole-breast ultrasound (ABUS) to produce finely detailed images of breast tissue. Sound waves are emitted by a portable instrument known as a transducer during the process.

The waves reflect off the breast tissue and return to the device, where they are transformed into images. The technology can differentiate between breast tissues because ultrasonic waves travel at different speeds depending on tissue type.

Particularly in dense breast tissue, where mammography may be less useful, the images generated provide a clear view of the breast's interior and help identify anomalies, such as tumors or lesions.

How Does Breast Density Affect Image Quality?

Let us talk about how breast density can affect your imaging. Dealing with dense breasts can really complicate imaging, but thankfully, we have many options. Breast imaging quality is strongly influenced by breast density. Dense breasts have a higher percentage of glandular and fibrous tissue than fatty tissue.

Abnormalities in the breast may be more difficult to detect with imaging methods like mammography. Because dense tissue and tumors show white on the picture, making them harder to differentiate, mammograms may miss up to 50% of breast malignancies in dense breasts.

Ultrasound, specifically automated whole breast ultrasound (ABUS), is a useful secondary screening method for women with dense breasts because it can better penetrate dense tissues and produce images that are sharper and more detailed.

How Is the Automated Whole Breast Ultrasound Procedure Performed?

To help you better understand, here is how an ABUS scan is done step by step:

1. You lie on your back in a comfortable position. A small wedge is placed under your shoulder to flatten the breast and enhance contact.

2. The radiologist will apply enough lotion to remove air gaps and prevent nipple-area artifacts.

3. A special automated transducer, called an ultrasound scanner, moves over your breast with light pressure.

4. The machine scans the breast in three primary views:

• Anteroposterior (front view) - nipple is the center point.

• Lateral view - scanning from the armpit toward the breastbone.

• Medial view - scanning from the breastbone toward the armpit.

5. Sometimes, superior/inferior views are added when breasts are larger.

6. Each breast takes approximately 10 to 15 minutes to scan.

7. The system captures approximately 448 thin image slices, each 0.5 millimeters thick.

8. These images are then combined into a 3-dimensional view and transmitted to the workstation.

9. Reading and analyzing the images takes approximately nine minutes.

What Are the Interpretations of Automated Whole Breast Ultrasound?

Here is what your radiologist is actually looking for when they read an AWBU scan.

• They use the comprehensive coronal view to visualize the entire breast. They check everything, such as where a lesion is located, how big it is, its shape, and the extent of its borders.

• The brightness and appearance of the lesion help doctors diagnose the lesion. On ultrasound, whether it looks even or uneven helps doctors identify if it might be breast cancer.

• In automated whole-breast ultrasound, a star-shaped pattern around a breast lesion, known as the retraction phenomenon, may indicate cancer.

• In automated whole-breast ultrasonography, the white wall sign appears as an echogenic wall in the coronal view. It signals benign breast lesions such as simple cysts (fluid-filled cavities), papillomas (non-cancerous tumors), and fibroadenomas (non-cancerous solid breast lumps).

• Automated, coronal-view ultrasonography of the entire breast can distinguish non-mass lesions from malignancies, such as papillary neoplasm and ductal carcinoma in situ.

What Are the Factors That Affect the Quality of the Automated Whole Breast Ultrasound Images?

1. Inadequate communication between the transducer and the breast's skin.

2. Shadow of the breasts.

3. The breast's fibrotic tissue shadows.

4. The effects of the lingering sound.

5. Radiologists with little experience and inadequate training.

Conclusion

ABUS is a potent complementary tool if you or your loved one has dense breast tissue, which helps in the diagnosis of cancers that may not be picked up on mammography alone. It provides detailed 3D imaging with clearer visualization of lesions, enhancing early detection, thereby improving diagnostic accuracy and timely treatment, and ultimately improving outcomes.

Concerned about breast cancer screening when you have dense breasts? Our iCliniq oncologist explains how automated whole breast ultrasound (ABUS) can be added to your screening plan, clarifying your options and guiding you toward a higher level of detection for better health outcomes.

Key Takeaways

• ABUS detects more cancers in women with dense breasts when added to mammography.

• Provides high-resolution 3D images of lesions not visible on X-ray.

• Helps to differentiate benign from malignant features using coronal-view markers.

• This will enhance early diagnosis and, consequently, less invasive and more effective treatment.