Fig. 1.

Invasive ductal carcinoma with ductal carcinoma in situ component in 59-year-old woman.

A. HHUS shows 15 mm spiculated, irregular hypoechoic mass (arrows) with posterior shadowing in left breast. Orientation of mass is antiparallel and final assessment is BI-RADS category 5. B, C, D. Three readers detected same mass (arrows) on three dimensional AWUS multiplanar images. This is representative case that showed perfect interobserver agreement: all readers agreed on shape (irregular), orientation (antiparallel), margin (spiculated), echogenicity (hypoechoic), posterior feature (shadowing) and BI-RADS category (category 5). AWUS = automatic whole breast ultrasound, BI-RADS = breast imaging reporting and data system, HHUS = hand held ultrasound