To compare the diagnostic efficacy of the remote-reading mode of Automated Breast Ultrasound (ABUS) and Handheld Ultrasound (HHUS) for breast cancer in county-wide hospitals, and to evaluate the clinical performance of the ABUS remote-reading mode in breast cancer screening.

A total of 454 women who underwent breast examinations at the Maternal and Child Health Hospital of Longchuan County, Guangdong Province, from April to October 2021 were retrospectively included. All of them completed both HHUS and ABUS examinations and were assigned BI-RADS classifications accordingly. The scanning and image-reading of HHUS were performed by four ultrasound physicians with over 5 years of experience in breast ultrasound, and the time spent was recorded. ABUS image acquisition was conducted by a technician with at least one year of work experience. The whole-breast images were transmitted to a reading center via dedicated software. Two ultrasound physicians with more than 5 years of experience in breast-specific ultrasound independently interpreted the images and recorded the time spent. All ultrasound images were indepentty reviewed by the readers in a blinded manner. Malignant cases were confirmed by histopathology, while benign and normal cases were confirmed by pathology or two-year follow-up results. The McNemar's test was used to compare sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV); the DeLong's test was used for area under the curve (AUC) comparison; the paired-samples t-test was applied to compare total time and ultrasound physician time; and the chi-square test was used to compare the proportional distribution of BI-RADS 1~2, 3, and 4~5 categories.

A total of 454 women were included in our study, with a mean age of (41.49±7.08) years (range: 20~67 years). There were 9 malignant cases and 445 benign and normal cases. Nine malignant cases were detected by ABUS and six by HHUS. Statistically significant differences were found between the two examinations in specificity, positive predictive value, and the AUC (96.9% and 90.8%, P＜0.01; 39.1% and 12.8%, P＜0.01; 0.99 and 0.85, P=0.028, respectively). The average total time spent was (836±78) seconds for ABUS and (311±77) seconds for HHUS; the average ultrasound physician time spent was (236± 31) seconds for ABUS and (311±77) seconds for HHUS (all P＜0.05). For ABUS and HHUS, respectively, the proportions of BI-RADS 1~2 lesions were 68.7% (312/454) and 54.2% (246/454), BI-RADS 3 were 26.2% (119/454) and 35.5% (161/454), and BI-RADS 4~5 were 5.1% (23/454) and 10.4% (47/454). All intergroup differences were statistically significant (P＜0.05).

In county-wide hospital settings, the remote-reading mode of ABUS demonstrates higher diagnostic performance for breast cancer compared with HHUS, and the diagnostic time consumed by ultrasound physicians for ABUS is shorter than that for HHUS.