ABVS technology is being actively studied for cancer examination both as a screening technology and as replacement for HHUS as an automatic method. Most publications have compared the performance of ABVS and HHUS. The second most frequent are studies of the opinions of experts on certain BI-RADS-specified characteristics of breast masses described by the two methods. Currently, data is being accumulated on mass screening programs using ABUS technology. Only a few publications discuss the scanning technique. And even fewer articles analyze the comparability of tumor size measured by ABVS with the findings of surgery.

Kelly et al. [1] performed a multicenter prospective study of 4419 women with dense glandular tissue and/or risk of breast cancer development. They compared the capabilities of mammography in combination with semiautomatic whole-breast ultrasound (WBUS) and other radiological techniques [1]. This work showed promising results. An additional 3.6 cancers detected per 1,000 women screened were reported, and these results are consistent with the recommendations of the American College of Radiology [1]. The sensitivity of semiautomatic WBUS as a single method was 67 % (38/57) and of mammography alone was 40 % (23/57); however, with the combined approach, the sensitivity increased to 81 % (46/57). According to the data, automated whole-breast ultrasound doubles the cancer detection rate and triples the identification of invasive cancers sized less than 1 cm [1].

Kelly et al. [2] also analyzed radiologists’ performance for cancer detection in women with dense glandular tissue using ABUS. They found that the radiologists were able to improve cancer detection with an increase of 63 % in the callbacks of cancer cases and only a 4 % decrease in the correct identification of true-negative cases. They concluded that ABUS will play a significant role in the screening of women with dense breast tissue [2].

Golatta et al. [3] studied 983 patients and 1966 breasts. On the basis of biopsies carried out in the USA, they reported a high predictive value of a negative test result, which was 98 % (1520/1551 cases), with high specificity of 85 % (1794/1520) and sensitivity of 74 % (88/119). Therefore they suggested that ABUS could be a promising method for breast studies, especially in screening programs [3]. This is the basic study assessing the possibilities of the method based on pathologic morphology.

Table 2.1 presents the main studies and conclusions obtained by the authors during ABUS [1–7].

According to numerous studies, ABVS is not inferior to conventional handheld US in detection and differential diagnosis of breast neoplasms while also exceeding it in some features. The informative value of ABVS is equivalent to HHUS in describing mass features and final assessment according to BI-RADS.

In 2011, Shin HJ et al. studied 55 women with 145 breast masses [4]. Five radiologists with varying experience detected from 74 to 88 % of the masses; substantial agreement was reached on the description of the mass features (k = 0.61−0.72) and BI-RADS final assessment category (k = 0.63). According to the study, ABVS can identify masses larger than 1.2 cm in 92.0 % of cases.

According to the recent publication of Golatta et al. [3], with analysis of 84 ABVS breast cancer examinations in 42 women by six breast diagnostic specialists unaware of the results of breast imaging and medical history, it was revealed that agreement of ABVS examination to HHUS, mammography, and pathology was fair to substantial depending on the specific analysis kappa value for all lesions (k = 0.35). Agreement improved when dichotomizing the interpretation into benign (BI-RADS 1,2) and suspicious (BI-RADS 4,5)—kappa value –0.52 [5]. Wojcinski S et al. in 2011 and in 2013 obtained the same results for interobserver concordance (k = 0.36). And with respect to the true category, the conditional inter-rate validity coefficient was kappa −0.18 for benign cases and kappa –0.80 for malignant cases. The likelihood of missing cancer in this method is very low. The authors concluded that ABVS examination in addition to mammography alone could detect a relevant number of previously occult breast cancers. However, the method had a high number of false-positive results, with a rate of second-look ultrasounds of up to 48.8 % [6].

The first work by Wojcinski et al. [7] provided data on the one hand promising and on the other hand ambiguous for ABVS diagnostic performance and interobserver concordance: sensitivity (100 %), limited accuracy of the method (66 %), and dubious specificity (52.8 %) [7]. In subsequent work [6], the sensitivity of ABVS reduced to 83 %, and the number of false-positive results increased. The authors considered the differences in expert opinion relative to the character and nature of the masses when using ABVS as significant. They consider that this method is not yet ready to be employed for screening [6].

Despite this, in the USA and Canada, this method is positioned as a screening method to be used in women in a risk group for breast cancer. The authors of the study ACRIN 6666 described the following potential benefits of ABUS as a screening method in comparison with conventional US: standardization while conducting the ultrasound study, reduced operator dependence, and saving the physician’s time [8]. And in Europe researchers consider the method as the best in women with already identified masses in the BI-RADS 3, 4, and 5 score group, to exclude or confirm signs of malignancy. Despite high accuracy, ABVS must still be regarded as an experimental technique for conclusion, which definitely needs further evaluation studies, as conducted by Wojcinski in 2011 [1]. The multicenter study by Lander et al. in 2011 evaluated the importance of ABVS as compared to conventional HHUS to identify masses in breast cancer screening programs [9]. According to numerous data, ABVS missed none of the breast cancers studied [10, 11]. Also, ABVS allows identification of additional masses and can replace HHUS in repeated ultrasound examinations [12].

Thus, the use of ABVS only for cancer identification in breasts provides a high sensitivity of examination, reaching 83–100 %. This will maximize the specificity and precision of ABVS in identifying cancer in a specially selected group of women, for example, with BI-RADS types 4 and 5.

Comparative studies of ABVS and HHUS for differentiation of benign and malignant breast lesions showed similarity or superiority of diagnostic accuracy of ABVS in numerous papers (Table 2.2) [13, 22–25]. Wang and Chen [13, 14] reported that ABVS is a promising modality for the clinical diagnosis of breast masses with retraction phenomenon and hyperechoic rim in the coronal plane, although the modalities do not differ in accuracy for the differentiation of breast masses; in a study of 81 patients by Lin et al. [15], ABVS and HHUS exhibited high sensitivity (both 100 %) and high specificity (95.0 % and 85.0 %, respectively). This high sensitivity of the method is enabled by the identifying of the “retraction” phenomenon on the coronal plane. This phenomenon, according to Lin et al., has 100 % specificity, 80 % sensitivity, and 91.4 % accuracy in differentiating benign and malignant breast masses [15]. The authors concluded that automated breast volume scanning is a promising modality in breast imaging; it provides advantages of better lesion size prediction, operator independence, and visualization of the whole breast. Another interesting work was that of Xu et al. [17] in which they evaluated the role of both ABVS and US elastography. They reported that both methods showed substantial interobserver reliability and the combined use of ABVS and US elastography was useful in improving diagnostic accuracy and specificity.