Adjunct Automated Breast Ultrasound in Mammographic Screening: A Systematic Review and Meta-Analysis.

Area of Science:

• Radiology and Medical Imaging
• Oncology
• Diagnostic Technologies

Background:

• Mammographic sensitivity is limited in women with dense breasts, increasing the risk of interval cancers.
• Automated breast ultrasound (ABUS) and ultrasound tomography (UST) are emerging as supplemental screening tools.
• Existing reviews lack focus on screening settings and direct comparisons with handheld ultrasound (HHUS).

Purpose of the Study:

• To systematically evaluate the effectiveness of ABUS and UST as adjuncts to mammographic screening.
• To compare the diagnostic accuracy of ABUS and UST against HHUS in screening settings.
• To assess the impact of ABUS on cancer detection rates and recall rates in women with dense breasts.

Main Methods:

• Systematic literature search of PubMed, Embase, Web of Science, and Cochrane Library (2000-2025).
• Inclusion of 18 studies (over 20,000 episodes) evaluating ABUS/ABVS or UST as adjuncts to mammography.
• Meta-analysis of sensitivity and specificity using random-effects models for comparable studies.

Main Results:

• Adding ABUS to mammography increased sensitivity by 6-35 percentage points, improving cancer detection by 2.4-4.3 per 1000 women.
• ABUS use was associated with higher recall rates and a modest decrease in specificity.
• Head-to-head comparison showed ABUS sensitivity of 0.90 and specificity of 0.89, comparable to HHUS.

Conclusions:

• ABUS is a practical and scalable adjunct to mammography, enhancing cancer detection in women with dense breasts.
• The benefits of increased cancer detection come with a trade-off of higher recall and reduced specificity.
• Further high-quality trials are needed due to study heterogeneity and risk of bias before widespread adoption in screening programs.