Korean J Radiol.  2013 Apr;14(2):154-163. 10.3348/kjr.2013.14.2.154.

Radiologists' Performance for Detecting Lesions and the Interobserver Variability of Automated Whole Breast Ultrasound

• Kim SH
• Kang BJ
• Choi BG
• Choi JJ
• Lee JH
• Song BJ
• Choe BJ
• Park S
• Kim H

• KMID: 1482772
• DOI: http://doi.org/10.3348/kjr.2013.14.2.154

Abstract

OBJECTIVE
To compare the detection performance of the automated whole breast ultrasound (AWUS) with that of the hand-held breast ultrasound (HHUS) and to evaluate the interobserver variability in the interpretation of the AWUS.
MATERIALS AND METHODS
AWUS was performed in 38 breast cancer patients. A total of 66 lesions were included: 38 breast cancers, 12 additional malignancies and 16 benign lesions. Three breast radiologists independently reviewed the AWUS data and analyzed the breast lesions according to the BI-RADS classification.
RESULTS
The detection rate of malignancies was 98.0% for HHUS and 90.0%, 88.0% and 96.0% for the three readers of the AWUS. The sensitivity and the specificity were 98.0% and 62.5% in HHUS, 90.0% and 87.5% for reader 1, 88.0% and 81.3% for reader 2, and 96.0% and 93.8% for reader 3, in AWUS. There was no significant difference in the radiologists' detection performance, sensitivity and specificity (p > 0.05) between the two modalities. The interobserver agreement was fair to good for the ultrasonographic features, categorization, size, and the location of breast masses.
CONCLUSION
AWUS is thought to be useful for detecting breast lesions. In comparison with HHUS, AWUS shows no significant difference in the detection rate, sensitivity and the specificity, with high degrees of interobserver agreement.

Keyword

Breast; Ultrasonography; Observer variation

MeSH Terms

Aged
Breast Neoplasms/pathology/*ultrasonography
Chi-Square Distribution
*Clinical Competence
Diagnosis, Differential
Female
Humans
Image Interpretation, Computer-Assisted/methods
Magnetic Resonance Imaging
Middle Aged
Neoplasm Staging
Observer Variation
Sensitivity and Specificity
Ultrasonography, Mammary/*methods

Figure

• 

  Fig. 1 Invasive ductal carcinoma with ductal carcinoma in situ component in 59-year-old woman. A. HHUS shows 15 mm spiculated, irregular hypoechoic mass (arrows) with posterior shadowing in left breast. Orientation of mass is antiparallel and final assessment is BI-RADS category 5. B, C, D. Three readers detected same mass (arrows) on three dimensional AWUS multiplanar images. This is representative case that showed perfect interobserver agreement: all readers agreed on shape (irregular), orientation (antiparallel), margin (spiculated), echogenicity (hypoechoic), posterior feature (shadowing) and BI-RADS category (category 5). AWUS = automatic whole breast ultrasound, BI-RADS = breast imaging reporting and data system, HHUS = hand held ultrasound

• 

  Fig. 2 Invasive ductal carcinoma in 45-year-old woman. A. HHUS shows 20 mm spiculated, irregular hypoechoic mass (arrows) in right breast. B. One HHUS reader detected same mass (arrows) on three dimensional AWUS multiplanar images. Two readers missed this lesion. AWUS = automated whole ultrasonography, HHUS = hand held ultrasound

• 

  Fig. 3 Mucinous carcinoma in right breast and invasive ductal carcinoma in left breast in 62-year-old woman. A. HHUS shows 30 mm indistinct irregular hypoechoic mass (arrows) with combined posterior features in left breast. Orientation of mass is parallel and final assessment is BI-RADS category 4. B, C, D. Three readers detected same mass (arrows) on three dimensional AWUS multiplanar images. This is representative case that showed fair interobserver agreement for margin. Three readers agreed on shape (irregular), orientation (parallel), echogenicity (hypoechoic) and BI-RADS category (category 4). Readers did not agree on margin and posterior features. Descriptive terms that were used were indistinct, angular and spiculated for margin and shadowing and were combined for posterior features. AWUS = automatied whole breast ultrasound, BI-RADS = breast imaging reporting and data system, HHUS = hand held ultrasound

• 

  Fig. 4 Invasive ductal carcinoma in right breast with multifocal malignancy in 70-year-old woman. A. HHUS shows breast cancer (arrows) with multifocal malignancy (arrowhead) at right upper breast. B. Three readers detected multifocal malignancy (arrowhead) adjacent to breast cancer (arrows) on three dimensional AWUS multiplanar images. AWUS = automatic whole breast ultrasound, HHUS = hand held ultrasound

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  Fig. 5 Fibrocystic disease in 51-year-old woman with invasive ductal carcinoma in right breast. A. Axial contrast-enhanced MR image shows oval enhancing mass (arrow) in left subareolar area. B. Second look US shows 9 mm circumscribed oval isoechoic mass (arrows) in left subareolar area. C, D. Two readers detected same mass (arrowheads) on three dimensional AWUS multiplanar images. E. One reader missed lesion and reader detected pseudolesion (arrow) just beside isoechoic mass (arrowheads). AWUS = automatic whole breast ultrasound, US = ultrasonography

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