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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



This study aimed to evaluate automated breast ultrasound (ABUS) compared to hand-held traditional ultrasound (HHUS) in the visualisation and BIRADS characterisation of breast lesions.

Materials and methods

From January 2016 to January 2017, 1,886 women with breast density category C or D (aged 48.6±10.8 years) were recruited. All participants underwent ABUS and HHUS examination; a subcohort of 1,665 women also underwent a mammography.


The overall agreement between HHUS and ABUS was 99.8 %; kappa=0.994, p<0.0001. Two cases were graded as BI-RADS 1 in HHUS, but were graded as BIRADS 4 in ABUS; biopsy revealed a radial scar. Three carcinomas were graded as BI-RADS 2 in mammography but BI-RADS 4 in ABUS; two additional carcinomas were graded as BI-RADS 2 in mammography but BI-RADS 5 in ABUS. Two carcinomas, appearing as a well-circumscribed mass or developing asymmetry in mammography, were graded as BI-RADS 4 in mammography but BI-RADS 5 in ABUS.


ABUS could be successfully used in the visualisation and characterisation of breast lesions. ABUS seemed to outperform HHUS in the detection of architectural distortion on the coronal plane and can supplement mammography in the detection of non-calcified carcinomas in women with dense breasts.

Key Points

The new generation of ABUS yields comparable results to HHUS.

ABUS seems superior to HHUS in detecting architectural distortions.

In dense breasts, supplemental ABUS to mammography detects additional cancers.

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Three-dimensional automated breast ultrasound system


Atypical ductal hyperplasia


Atypical lobular hyperplasia


Breast Imaging Reporting and Data System


Ductal carcinoma in situ


Full-digital mammography


Field of view


Hand-held ultrasound


Invasive ductal carcinoma


Invasive lobular carcinoma


Lobular carcinoma in situ


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The authors would like to thank the technologists Kalliopi Konstantinakou and Evangelia Stamatiou for their contribution in performing ABUS, mammography and collecting the data.

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Corresponding author

Correspondence to Athina Vourtsis.

Ethics declarations


The scientific guarantor of this publication is Athina Vourtsis MD, PhD, Founding President of the Hellenic Breast Imaging Society.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: The corresponding author has received honoraria from GE Healthcare for giving lectures and for moderating workshops.


The authors state that this work has not received any funding.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• prospective

• observational

• performed at one institution

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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 28, 592–601 (2018).

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  • Automated breast ultrasound system
  • Breast ultrasonography
  • Breast cancer
  • Breast density
  • Digital mammography