Role of Automated Breast 3D Ultrasound and Post-Contrast Mammography in Detection and Characterization of Different Breast Lesions Referred to Pathological Results

Abstract

Purpose: To evaluate and compare the diagnostic performance of Automated Breast Ultrasound (ABUS) and Contrast-Enhanced Digital Mammography (CEDM) in the detection and characterization of breast lesions, using histopathological findings as the reference standard, and to assess their complementary roles—particularly in patients with dense breast tissue or non-mass enhancement patterns.

Material and Methods: In this prospective study, 42 women with clinically or radiologically suspicious breast lesions underwent both ABUS and CEDM, between September 2022 and April 2024. Histopathological diagnosis was used as the reference standard. Diagnostic performance metrics, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated for both modalities.

Results: Among 53 detected lesions, 38 (72%) were malignant and 15 (28%) benign. ABUS achieved 100% sensitivity, 73.33% specificity, 90.48% PPV, and 100% NPV, with an overall accuracy of 92.45%. CEDM demonstrated 100% sensitivity, 60% specificity, 86.36% PPV, and 100% NPV, with an accuracy of 88.68%. ABUS was particularly effective in identifying key morphological features such as lesion orientation, retraction phenomena, and ductal extension. CEDM provided enhanced detection of non-mass enhancement patterns often linked to early-stage malignancies.

Conclusions: Both ABUS and CEDM exhibit high diagnostic accuracy and sensitivity in breast lesion evaluation. ABUS offers higher specificity and structural detail, while CEDM enhances vascular visualization. Their combined use may significantly improve diagnostic confidence, especially in patients with dense breast tissue.