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Automated breast ultrasound (ABUS): A pictorial essay of common artifacts and benign and malignant pathology

Dima Al Jahed
Dima Al Jahed
, 
Sofie Dekeyzer
Sofie Dekeyzer
, 
Katrien Vanwambeke
Katrien Vanwambeke
, 
Marijana Antic
Marijana Antic
, 
Charlotte Vanhoenacker
Charlotte Vanhoenacker
 y 
Filip Vanhoenacker
Filip Vanhoenacker
   | 01 oct 2022
Journal of Ultrasonography's Cover Image
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Article Category: pictorial-essay
Publicado en línea: 01 oct 2022
Páginas: e222 - e235
Recibido: 01 jun 2022
Aceptado: 26 jul 2022
DOI: https://doi.org/10.15557/jou.2022.0037
Palabras clave
© 2022 Dima Al Jahed et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1.

Transducer plate. Wide and curved high-resolution transducer (A, B) used for ABUS images for much wider footprint than handheld ultrasound (HHUS) to ensure a uniform compression across the entire breast. Wide bandwidth with a large imaging field of view (FOV) with wide beams in multiple angles, compared to focused beams in HHUS (C). (Images used with kind permission from GE Healthcare, USA)
Transducer plate. Wide and curved high-resolution transducer (A, B) used for ABUS images for much wider footprint than handheld ultrasound (HHUS) to ensure a uniform compression across the entire breast. Wide bandwidth with a large imaging field of view (FOV) with wide beams in multiple angles, compared to focused beams in HHUS (C). (Images used with kind permission from GE Healthcare, USA)

Fig. 2.

Examination position. Supine position with rising arm above the head to acquire the ABUS views covering the breast while using a pillow under the patient’s shoulder to get an adequate compression (A, B, C). ABUS equipment used in our department – Invenia™ (GE Healthcare, USA, used with permission) (D)
Examination position. Supine position with rising arm above the head to acquire the ABUS views covering the breast while using a pillow under the patient’s shoulder to get an adequate compression (A, B, C). ABUS equipment used in our department – Invenia™ (GE Healthcare, USA, used with permission) (D)

Fig. 3.

Scanning views, Overview of the ABUS scanning views (A) with three standard views anteroposterior (AP), lateral (LAT), and medial (MED) and additional six views are needed depending on patient body habitus to cover the entire volume of an individual breast. (B, C). (Images used with kind permission from GE Healthcare, USA)
Scanning views, Overview of the ABUS scanning views (A) with three standard views anteroposterior (AP), lateral (LAT), and medial (MED) and additional six views are needed depending on patient body habitus to cover the entire volume of an individual breast. (B, C). (Images used with kind permission from GE Healthcare, USA)

Fig. 4.

Imaging planes on ABUS: axial (A) and coronal AP (B). Note the typical “donut” shape on the AP coronal plane with the nipple in the center
Imaging planes on ABUS: axial (A) and coronal AP (B). Note the typical “donut” shape on the AP coronal plane with the nipple in the center

Fig. 5.

Retraction sign. Coronal lateral ABUS image of the right breast in a 64-year-old woman shows a strong retraction pattern (white arrow) of the tumor at the upper lateral quadrant. The nipple is marked by the yellow dot
Retraction sign. Coronal lateral ABUS image of the right breast in a 64-year-old woman shows a strong retraction pattern (white arrow) of the tumor at the upper lateral quadrant. The nipple is marked by the yellow dot

Fig. 6.

Drop-out artifact. ABUS in a 21-year-old woman. Coronal anteroposterior (A) and axial (B) ABUS images of the right breast show a large drop-out artifact as a longitudinal black area (between arrows) along the lateral section of the right breast
Drop-out artifact. ABUS in a 21-year-old woman. Coronal anteroposterior (A) and axial (B) ABUS images of the right breast show a large drop-out artifact as a longitudinal black area (between arrows) along the lateral section of the right breast

Fig. 7.

Air contact artifact. ABUS in a 54-year-old woman. Coronal anteroposterior (A) and axial (B) ABUS images from the right breast show an air contact artifact as a black hole (arrow) lateral to the right nipple (yellow dot). The nipple is marked by the yellow dot (A)
Air contact artifact. ABUS in a 54-year-old woman. Coronal anteroposterior (A) and axial (B) ABUS images from the right breast show an air contact artifact as a black hole (arrow) lateral to the right nipple (yellow dot). The nipple is marked by the yellow dot (A)

Fig. 8.

Nipple shadowing obscuring breast cancer. ABUS images of the left breast in a 54-year-old woman. The reconstructed coronal anteroposterior ABUS plane (A) demonstrates an invasive ductal carcinoma (arrow) in the paraareolar area with relatively mild nipple shadowing. Axial ABUS image (B) shows more prominent nipple shadowing obscuring the cancer completely (arrow)
Nipple shadowing obscuring breast cancer. ABUS images of the left breast in a 54-year-old woman. The reconstructed coronal anteroposterior ABUS plane (A) demonstrates an invasive ductal carcinoma (arrow) in the paraareolar area with relatively mild nipple shadowing. Axial ABUS image (B) shows more prominent nipple shadowing obscuring the cancer completely (arrow)

Fig. 9.

Wandering shadows in a 50-year-old woman with heterogeneously dense breasts. The axial images from a normal ABUS examination of the right breast shows multiple wandering shadows as dark parallel repetitive linear areas (white arrows). These are caused by sound waves that refract and scatter from the curved surface of Cooper’s ligaments, causing wandering shadows in the breast
Wandering shadows in a 50-year-old woman with heterogeneously dense breasts. The axial images from a normal ABUS examination of the right breast shows multiple wandering shadows as dark parallel repetitive linear areas (white arrows). These are caused by sound waves that refract and scatter from the curved surface of Cooper’s ligaments, causing wandering shadows in the breast

Fig. 10.

Sinusoidal distortion due to heavy breathing in a 70-year-old woman. Coronal anteroposterior (A) and axial ABUS image (B) of the left breast show patterns of heavy breathing artifacts during the acquisition as a cluster of straight lines which are most conspicuous at the posterior deepest aspect of the left breast (between arrows). Nipple shadowing also showed on the axial image (B, yellow dot)
Sinusoidal distortion due to heavy breathing in a 70-year-old woman. Coronal anteroposterior (A) and axial ABUS image (B) of the left breast show patterns of heavy breathing artifacts during the acquisition as a cluster of straight lines which are most conspicuous at the posterior deepest aspect of the left breast (between arrows). Nipple shadowing also showed on the axial image (B, yellow dot)

Fig. 11.

Skip artifact. Coronal lateral ABUS images (A, B) of the right breast shows a straight horizontal line (white arrow) caused by a lack of skin contact of the probe due to skipping of the transducer at the nipple
Skip artifact. Coronal lateral ABUS images (A, B) of the right breast shows a straight horizontal line (white arrow) caused by a lack of skin contact of the probe due to skipping of the transducer at the nipple

Fig. 12.

White wall artifact in a cyst. Coronal anteroposterior reconstruction ABUS image (A) shows a round echogenic capsule (white arrow), in the right breast. This is corresponding to the posterior enhancement of the cyst on the axial plane (B) (white arrows)
White wall artifact in a cyst. Coronal anteroposterior reconstruction ABUS image (A) shows a round echogenic capsule (white arrow), in the right breast. This is corresponding to the posterior enhancement of the cyst on the axial plane (B) (white arrows)

Fig. 13.

Surgical scars and clips shadowing. Lateral coronal (A) and axial plane (B) ABUS images in a 65-year-old woman show a hypoechoic region with lobulated margins and strong posterior shadowing surrounding a metallic surgical clip within the operated area in the upper outer quadrant of the left breast (white arrow). The nipple is marked with the yellow dot on the lateral coronal view (A)
Surgical scars and clips shadowing. Lateral coronal (A) and axial plane (B) ABUS images in a 65-year-old woman show a hypoechoic region with lobulated margins and strong posterior shadowing surrounding a metallic surgical clip within the operated area in the upper outer quadrant of the left breast (white arrow). The nipple is marked with the yellow dot on the lateral coronal view (A)

Fig. 14.

Multiple cysts in the upper lateral quadrant of the right breast. Coronal anteroposterior (A) and axial (B) ABUS images in a 38-year-old woman show multiple cysts (white arrows) with an overall acoustic enhancement and subtle intralesional reflections. There are no solid components, and the long axis is parallel to the skin on the axial image
Multiple cysts in the upper lateral quadrant of the right breast. Coronal anteroposterior (A) and axial (B) ABUS images in a 38-year-old woman show multiple cysts (white arrows) with an overall acoustic enhancement and subtle intralesional reflections. There are no solid components, and the long axis is parallel to the skin on the axial image

Fig. 15.

Fibroadenoma. Coronal lateral (A) and axial (B) ABUS images of the right breast in a 32-year-old woman with heterogeneously dense breasts and negative screening mammography. ABUS images show a circumscribed hypoechoic lesion (white arrow) within a fine peripheral capsule. The lesion has no posterior acoustic features or the sign of retraction on the coronal plane
Fibroadenoma. Coronal lateral (A) and axial (B) ABUS images of the right breast in a 32-year-old woman with heterogeneously dense breasts and negative screening mammography. ABUS images show a circumscribed hypoechoic lesion (white arrow) within a fine peripheral capsule. The lesion has no posterior acoustic features or the sign of retraction on the coronal plane

Fig. 16.

Fat necrosis in a chronic stage. Lateral coronal reconstruction (A) and axial plane (B) ABUS images in a 63-year-old woman in the upper outer quadrant of the left breast shows a well-defined lesion with partial cystic components with debris (white arrow and white asterisk) surrounded by edematous fat
Fat necrosis in a chronic stage. Lateral coronal reconstruction (A) and axial plane (B) ABUS images in a 63-year-old woman in the upper outer quadrant of the left breast shows a well-defined lesion with partial cystic components with debris (white arrow and white asterisk) surrounded by edematous fat

Fig. 17.

Intramammary lymph node in the upper outer quadrant of the left breast. Coronal lateral plane (A), axial plane ABUS images (B) and enlarged axial view (C) in a 42-year-old woman show a circumscribed oval lesion with a hyperechoic fatty hilum and hypoechoic peripheral cortex (white arrow)
Intramammary lymph node in the upper outer quadrant of the left breast. Coronal lateral plane (A), axial plane ABUS images (B) and enlarged axial view (C) in a 42-year-old woman show a circumscribed oval lesion with a hyperechoic fatty hilum and hypoechoic peripheral cortex (white arrow)

Fig. 18.

Papilloma. Coronal anteroposterior (A), coronal lateral (B) and axial (C) ABUS images of the right breast in a 38-year-old asymptomatic woman at a high risk of developing breast cancer. Notice an irregular hypoechoic lesion (white arrow) with a heterogeneous echo pattern and partial posterior acoustic enhancement (arrows). Histological core needle biopsy showed an intraductal papilloma without signs of invasive or in situ carcinoma or atypia
Papilloma. Coronal anteroposterior (A), coronal lateral (B) and axial (C) ABUS images of the right breast in a 38-year-old asymptomatic woman at a high risk of developing breast cancer. Notice an irregular hypoechoic lesion (white arrow) with a heterogeneous echo pattern and partial posterior acoustic enhancement (arrows). Histological core needle biopsy showed an intraductal papilloma without signs of invasive or in situ carcinoma or atypia

Fig. 19.

Radial scar/CSF. Coronal lateral (A) and axial (B) ABUS images from the left breast in a 30-year-old woman at a high risk of developing breast cancer. ABUS images showed an irregular, indistinct, hypoechoic lesion (white arrows) with posterior acoustic shadowing. Histological examination of the specimen obtained by core needle biopsy showed a CSL without signs of invasive or in situ carcinoma or atypia
Radial scar/CSF. Coronal lateral (A) and axial (B) ABUS images from the left breast in a 30-year-old woman at a high risk of developing breast cancer. ABUS images showed an irregular, indistinct, hypoechoic lesion (white arrows) with posterior acoustic shadowing. Histological examination of the specimen obtained by core needle biopsy showed a CSL without signs of invasive or in situ carcinoma or atypia

Fig. 20.

Lipoma. Coronal lateral (A) and axial (B) ABUS images of the left breast at the upper outer quadrant in a 46-year-old woman. Notice a well-defined hypoechoic lesion (white arrows) with the long axis parallel to the skin
Lipoma. Coronal lateral (A) and axial (B) ABUS images of the left breast at the upper outer quadrant in a 46-year-old woman. Notice a well-defined hypoechoic lesion (white arrows) with the long axis parallel to the skin

Fig. 21.

IDC. Coronal anteroposterior plane (A), coronal lateral (B) and axial (C) ABUS images of the right breast in a 64-year-old woman with heterogeneously dense breasts. ABUS images of the right breast show an irregular, hypoechoic mass with lobulated and spiculated margins, posterior acoustic shadowing, and a retraction pattern on the coronal image (white arrows). The nipple is marked with the yellow dot on the lateral coronal view (A, B). Histological evaluation revealed a 14-mm intermediate-grade IDC
IDC. Coronal anteroposterior plane (A), coronal lateral (B) and axial (C) ABUS images of the right breast in a 64-year-old woman with heterogeneously dense breasts. ABUS images of the right breast show an irregular, hypoechoic mass with lobulated and spiculated margins, posterior acoustic shadowing, and a retraction pattern on the coronal image (white arrows). The nipple is marked with the yellow dot on the lateral coronal view (A, B). Histological evaluation revealed a 14-mm intermediate-grade IDC

Fig. 22.

Triple negative IDA. Coronal lateral plane (A) and axial plane (B) ABUS images of the left breast in a 72-year-old woman with heterogeneously dense breasts. Notice an irregular hypoechoic mass (white arrow) with spiculated margins. A strong retraction phenomenon was seen on the coronal plane. Histological analysis confirmed a 15-mm IDA
Triple negative IDA. Coronal lateral plane (A) and axial plane (B) ABUS images of the left breast in a 72-year-old woman with heterogeneously dense breasts. Notice an irregular hypoechoic mass (white arrow) with spiculated margins. A strong retraction phenomenon was seen on the coronal plane. Histological analysis confirmed a 15-mm IDA

Fig. 23.

ILC. Coronal lateral plane (A) and axial (B) ABUS images in a 50-year-old woman with heterogeneously dense breasts. ABUS images of the right breast show an irregular non-parallel mass (white arrow) with indistinct and angular margins. An extensive retraction pattern is seen on the coronal image. Histological analysis confirmed a 12-mm ILC
ILC. Coronal lateral plane (A) and axial (B) ABUS images in a 50-year-old woman with heterogeneously dense breasts. ABUS images of the right breast show an irregular non-parallel mass (white arrow) with indistinct and angular margins. An extensive retraction pattern is seen on the coronal image. Histological analysis confirmed a 12-mm ILC
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