本研究评估了无症状女性中第二次自动乳腺超声（ABUS）辅助乳腺X线摄影（MAM）与MAM单独以及补充手持超声（HHUS）的作用，并将其与HHUS进行了比较。2018年至2022年期间，中国六家医院对年龄在45至64岁之间的女性进行了HHUS、ABUS和MAM。我们按年龄组和乳房密度比较了三种策略的筛查表现（MAM单独，MAM加HHUS，MAM加ABUS）。使用麦克尼马法（McNemar的检验）评估不同策略的癌症检测率（CDR），误诊活检率，灵敏度和特异度之间的差异。分析19,171名女性（平均[SD]年龄为51.54 [4.61]岁），发现了72例乳腺癌（3.76/1000）。 HHUS和ABUS与MAM相结合的检测率均显著高于MAM单独（所有p <0.001）的检测率。两种综合策略之间的癌症产率没有显著差异。综合策略的CDR增加在45-54岁且乳房较密集的女性比MAM单独更高（所有p <0.0167）。此外，MAM加ABUS的误诊活检率低于MAM加HHUS（p = 0.025）。此外，在通过MAM的阴性结果检测到的病例中，ABUS的回缩更为频繁。将ABUS或HHUS整合到MAM中提供了类似的CDR，并且在年轻女性（45-54岁）中显示出显著高于MAM单独的检测率，尤其是对于乳房密度较大的女性。ABUS有潜力避免不必要的活检，并提供特定图像特征以区分HHUS中的恶性肿瘤。版权所有©2023 The Association of University Radiologists。Elsevier Inc.发表，保留所有权利。

This study assessed the role of second-look automated breast ultrasound (ABUS) adjunct to mammography (MAM) versus MAM alone in asymptomatic women and compared it with supplementing handheld ultrasound (HHUS).Women aged 45 to 64 underwent HHUS, ABUS, and MAM among six hospitals in China from 2018 to 2022. We compared the screening performance of three strategies (MAM alone, MAM plus HHUS, and MAM plus ABUS) stratified by age groups and breast density. McNemar's test was used to assess differences in the cancer detection rate (CDR), the false-positive biopsy rate, sensitivity, and specificity of different strategies.Of 19,171 women analyzed (mean [SD] age, 51.54 [4.61] years), 72 cases of breast cancer (3.76 per 1000) were detected. The detection rates for both HHUS and ABUS combined with MAM were statistically higher than those for MAM alone (all p < 0.001). There was no significant difference in cancer yields between the two integration strategies. The increase in CRD of the integrated strategies was higher in women aged 45-54 years with denser breasts compared with MAM alone (all p < 0.0167). In addition, the false-positive biopsy rate of MAM plus ABUS was lower than that of MAM plus HHUS (p = 0.025). Moreover, the retraction in ABUS was more frequent in cases detected among MAM-negative results.Integrated ABUS or HHUS into MAM provided similar CDRs that were significantly higher than those for MAM alone in younger women (45-54 years) with denser breasts. ABUS has the potential to avoid unnecessary biopsies and provides specific image features to distinguish malignant tumors from HHUS.Copyright © 2023 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.