New Study Compares Automated vs. Handheld Breast Ultrasound for Women With Dense Breasts

New Research Compares Automated and Handheld Breast Ultrasound for Supplemental Screening

A 2026 study published in the Journal of the American College of Radiology found that automated breast ultrasound was associated with fewer abnormal interpretations and short-interval follow-up recommendations than handheld ultrasound, with no statistically significant difference in cancer detection rates.

As awareness of breast density continues to grow, healthcare providers are increasingly evaluating supplemental screening options for women with dense breast tissue. Automated breast ultrasound (ABUS) and handheld ultrasound (HHUS) are two approaches used alongside mammography to help detect breast cancer.

Understanding the Study

Researchers analyzed 25,328 supplemental breast ultrasound examinations performed between 2017 and 2020 at 27 radiology facilities participating in three Breast Cancer Surveillance Consortium registries.

The analysis included:

  • 4,218 automated breast ultrasound examinations
  • 21,110 handheld ultrasound examinations
  • Women ages 40–74 with heterogeneously or extremely dense breasts
  • Screening outcomes including abnormal interpretations, follow-up recommendations, biopsy recommendations, and cancer detection

The researchers sought to determine whether automated ultrasound could offer comparable screening performance while addressing some of the operator-dependent limitations associated with handheld ultrasound.

Key Findings:

  • ‍‍ Fewer Abnormal Interpretations and Follow-Up Recommendations
  • One of the most notable findings was the difference in abnormal interpretation rates.
  • After adjusting for patient risk and clinical factors, automated breast ultrasound had an abnormal interpretation rate of 14.9%, compared with 19.2% for handheld ultrasound.
  • Researchers also identified a substantial difference in short-interval follow-up recommendations.
  • Only 3.0% of automated ultrasound examinations resulted in short-interval follow-up recommendations, compared with 14.6% of handheld ultrasound examinations.
  • Automated ultrasound was also associated with fewer false-positive initial assessments: 14.6% compared with 19.1% for handheld ultrasound.

These findings suggest that automated ultrasound may help reduce certain additional screening recommendations in appropriately selected patients. Importantly, the researchers did not find statistically significant differences in biopsy recommendation rates or false-positive biopsy recommendations between the two approaches.

What About Breast Cancer Detection?

The study reported adjusted cancer detection rates of approximately 2.5 cancers per 1,000 automated ultrasound examinations and 1.7 cancers per 1,000 handheld ultrasound examinations. Although the observed rate was numerically higher with automated ultrasound, the difference was not statistically significant. The findings therefore support comparable observed cancer detection performance between the modalities rather than establishing that automated ultrasound detects more cancers.

Why These Findings Matter for Breast Imaging Providers

Handheld breast ultrasound relies on the individual performing the examination to acquire images and evaluate breast tissue in real time. Automated breast ultrasound uses a different acquisition approach, allowing images to be captured through a more standardized process and subsequently interpreted by a radiologist. This approach has the potential to reduce some of the variability associated with operator-dependent image acquisition. For imaging centers and healthcare providers considering supplemental breast screening services, the study contributes useful evidence regarding differences in screening outcomes, particularly abnormal interpretations and follow-up recommendations.

However, the researchers also acknowledged important limitations, including differences in clinical practices across facilities and the possibility of unmeasured factors influencing the results. Additional research is needed to better understand how these findings translate across different patient populations, technologies, and screening environments.

The Role of Automated Breast Ultrasound in Dense Breast Screening

Dense breast tissue can make abnormalities more difficult to identify on mammography because dense tissue and some cancers may appear similarly white on mammographic images. Supplemental ultrasound provides another imaging approach that may be considered for certain women based on their breast density, individual risk factors, and clinical circumstances. Technologies such as the SOFIA 3D Breast Ultrasound System from iVu Imaging are part of the evolving automated breast ultrasound landscape.

Although the 2026 study did not evaluate SOFIA specifically, its findings contribute to the growing body of research examining the role of automated ultrasound in supplemental breast cancer screening. As healthcare providers continue to evaluate breast screening strategies, evidence comparing automated and handheld ultrasound can help inform discussions about clinical workflows, screening outcomes, and patient care.

Learn More About SOFIA 3D Breast Ultrasound

iVu Imaging is committed to advancing awareness of supplemental breast imaging technologies and supporting informed conversations among healthcare providers.

Learn more about the SOFIA 3D Breast Ultrasound System.

Research Reference

Rauscher GH, Alsheik N, Eavey J, et al. Comparison of Supplemental Breast Cancer Screening Outcomes for Automated Versus Handheld Ultrasound. Journal of the American College of Radiology. 2026;23:1936–1945.

Read the published study

This article summarizes independently published research for educational purposes. The findings should not be interpreted as a direct clinical evaluation of the SOFIA system or as individualized medical advice.

October 30, 2026

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