Diagnostic Accuracy of Supplemental Breast Ultrasound in Breast Cancer Screening in Women With Dense Breasts
DOI:
https://doi.org/10.66201/ss.v1.20Keywords:
Supplemental Breast Ultrasound, Dense Breasts, Breast Cancer Screening, Automated Breast Ultrasound, Incremental Cancer Detection Rate, False PositivesAbstract
Background: Breast cancer is the most frequent malignant tumor in women worldwide. Mammography is the only screening method with evidence of mortality reduction; however, its sensitivity decreases markedly in the presence of dense breast tissue. This limitation justifies the evaluation of supplemental imaging modalities.
Methods: A narrative review of the literature was conducted, including studies published between January 2020 and April 2026 evaluating breast ultrasound—handheld (HHUS) or automated (ABUS)—as a supplemental modality to mammography in women with dense breasts (ACR BI-RADS categories C and D).
Results: Supplemental ultrasound increases the incremental cancer detection rate (ICDR) by 1.1 to 7.0 per 1,000 women screened compared to mammography alone. The DBTUST trial recorded an ICDR of 1.1/1,000 after supplemental ultrasound added to tomosynthesis. Canadian experiences reported ICDR of 6.1–7.0/1,000, with the majority of lesions detected at stage I. A meta-analysis confirmed a 51.5% increase in overall detection with ABUS versus mammography alone. A multicenter randomized clinical trial demonstrated diagnostic superiority of ABUS over HHUS (AUC 0.86 vs. 0.72). The false-positive rate increased between 4.5% and 14.9% depending on the modality.
Conclusion: Supplemental ultrasound consistently improves cancer detection in women with dense breasts, especially when access to magnetic resonance imaging is limited. ABUS reduces operator-dependent variability and shows promising results at the population level.
References
US Preventive Services Task Force, Nicholson WK, Silverstein M, Wong JB, Barry MJ, Chelmow D, et al. Screening for breast cancer: US preventive services task force recommendation statement. JAMA. 2024 Jun 11;331(22):1918-30. https://doi.org/10.1001/jama.2024.5534
Payne NR, Hickman SE, Black R, Priest AN, Hudson S, Gilbert FJ. Breast density effect on the sensitivity of digital screening mammography in a UK cohort. Eur Radiol. 2025 Jan;35(1):177-87. https://doi.org/10.1007/s00330-024-10951-w
Wu T, Warren LJ. The added value of supplemental breast ultrasound screening for women with dense breasts: A single center Canadian experience. Can Assoc Radiol J. 2022 Feb;73(1):101-6. https://doi.org/10.1177/08465371211011707
Mann RM, Athanasiou A, Baltzer PAT, Camps-Herrero J, Clauser P, Fallenberg EM, et al. Breast cancer screening in women with extremely dense breasts: Recommendations of the European Society of Breast Imaging (EUSOBI). Eur Radiol. 2022 Jun;32(6):4036-45. https://doi.org/10.1007/s00330-022-08617-6
Seely JM, Peddle SE, Yang H, Chiarelli AM, McCallum M, Narasimhan G, et al. Breast density and risk of interval cancers: The effect of annual versus biennial screening mammography policies in Canada. Can Assoc Radiol J. 2022 Feb;73(1):90-100. https://doi.org/10.1177/08465371211027958
Uematsu T. Rethinking screening mammography in Japan: Next-generation breast cancer screening through breast awareness and supplemental ultrasonography. Breast Cancer. 2024 Jan;31(1):24-30. https://doi.org/10.1007/s12282-023-01506-w
Sitges C, Mann RM. Breast MRI to screen women with extremely dense breasts. J Magn Reson Imaging. 2025 Jul;62(1):58-72. https://doi.org/10.1002/jmri.29716
Vegunta S, Kling JM, Patel BK. Supplemental cancer screening for women with dense breasts: Guidance for health care professionals. Mayo Clin Proc. 2021 Nov;96(11):2891-904. https://doi.org/10.1016/j.mayocp.2021.06.001
Xu Y, Xu Y, Shen S, Mao F, Zhang X, Zhang Y, et al. A multi-centre, randomised trial for diagnostic efficacy of the automatic breast volume scanner ultrasound for breast cancer screening in China. Front Oncol. 2024;14:1421425. https://doi.org/10.3389/fonc.2024.1421425
Berg WA, Zuley ML, Chang TS, Gizienski T-A, Chough DM, Böhm-Vélez M, et al. Prospective multicenter diagnostic performance of technologist-performed screening breast ultrasound after tomosynthesis in women with dense breasts: The DBTUST. J Clin Oncol. 2023 May 14;41(13):2403-15. https://doi.org/10.1200/jco.22.01445
Kellow Z, Seely JM. Supplemental screening for breast cancer and implementation. Can Assoc Radiol J. 2025 Aug;76(3):371-2. https://doi.org/10.1177/08465371251322076
Gordon PB, Warren LJ, Seely JM. Cancers detected on supplemental breast ultrasound in women with dense breasts: Update from a Canadian centre. Can Assoc Radiol J. 2025 Aug;76(3):497-507. https://doi.org/10.1177/08465371251318578
Ha SM, Yi A, Yim D, Jang M-J, Kwon BR, Shin SU, et al. Digital breast tomosynthesis plus ultrasound versus digital mammography plus ultrasound for screening breast cancer in women with dense breasts. Korean J Radiol. 2023 Apr;24(4):274-83. https://doi.org/10.3348/kjr.2022.0649
Allajbeu I, Hickman SE, Payne N, Moyle P, Taylor K, Sharma N, et al. Automated breast ultrasound: Technical aspects, impact on breast screening, and future perspectives. Curr Breast Cancer Rep. 2021 Sep;13(3):141-50. https://doi.org/10.1007/s12609-021-00423-1
Aribal E, Seker ME, Guldogan N, Yilmaz E. Value of automated breast ultrasound in screening: Standalone and as a supplemental to digital breast tomosynthesis. Int J Cancer. 2024 Oct 15;155(8):1466-75. https://doi.org/10.1002/ijc.35093
Gatta G, Somma F, Sardu C, De Chiara M, Massafra R, Fanizzi A, et al. Automated 3D ultrasound as an adjunct to screening mammography programs in dense breast: Literature review and metanalysis. J Pers Med. 2023 Dec 4;13(12):1683. https://doi.org/10.3390/jpm13121683
Klein Wolterink F, Ab Mumin N, Appelman L, Derks-Rekers M, Imhof-Tas M, Lardenoije S, et al. Diagnostic performance of 3D automated breast ultrasound (3D-ABUS) in a clinical screening setting: A retrospective study. Eur Radiol. 2024 Aug;34(8):5451-60. https://doi.org/10.1007/s00330-023-10568-5
Niu M, Zheng J, Feng X, Yan H, Jia M, Qi S, et al. Study on ABUS applicability for rural women with low health resources in China: Large-scale population, non-opportunistic screening. J Ultrasound Med. 2025 Sep;44(9):1531-43. https://doi.org/10.1002/jum.16708
Yan H, Wang Q, Zhao F, Kang D, Qiao Y. The evidence and concerns about screening ultrasound for breast cancer. Cancer Biol Med. 2025 Apr 26;22(4):j.issn.2095-3941.2024.0562. https://doi.org/10.20892/j.issn.2095-3941.2024.0562
Boca Bene I, Ciurea AI, Vesa Ștefan C, Ciortea CA, Dudea SM, Manole S. Associating automated breast ultrasound (ABUS) and digital breast tomosynthesis (DBT) with full-field digital mammography (FFDM) in clinical practice in cases of women with dense breast tissue. Diagnostics (Basel). 2022 Feb 11;12(2):459. https://doi.org/10.3390/diagnostics12020459
Ohnuki K, Tohno E, Tsunoda H, Uematsu T, Nakajima Y. Overall assessment system of combined mammography and ultrasound for breast cancer screening in Japan. Breast Cancer. 2021 Mar;28(2):254-62. https://doi.org/10.1007/s12282-020-01203-y
Sprague BL, Ichikawa L, Eavey J, Lowry KP, Rauscher G, O'Meara ES, et al. Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone. Cancer. 2023 Aug 15;129(16):2456-68. https://doi.org/10.1002/cncr.34768
Li C, Luo Y, Jiang Y, Wu X, Li Q. Developing a nomogram prediction model to enhance diagnostic accuracy of supplemental ultrasound post-negative mammography. Medicine (Baltimore). 2024 Dec 27;103(52):e41149. https://doi.org/10.1097/md.0000000000041149
Geuzinge HA, Bakker MF, Heijnsdijk EAM, van Ravesteyn NT, Veldhuis WB, Pijnappel RM, et al. Cost-effectiveness of magnetic resonance imaging screening for women with extremely dense breast tissue. J Natl Cancer Inst. 2021 Nov 2;113(11):1476-83. https://doi.org/10.1093/jnci/djab119
Stout NK, Miglioretti DL, Su Y-R, Lee CI, Abraham L, Alagoz O, et al. Breast cancer screening using mammography, digital breast tomosynthesis, and magnetic resonance imaging by breast density. JAMA Intern Med. 2024 Oct 1;184(10):1222-31. https://doi.org/10.1001/jamainternmed.2024.4224
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Bruna Eduarda Loli, Emanuelle De Melo Lacerda, Jose Mauricio Sivirino Silva, Andrea Paola Britos de Chaux (Autor/a)
This work is licensed under a Creative Commons Attribution 4.0 International License.
