The Role and Feasibility of Automated Breast Ultrasound in the Evaluation of Male Breast Disease: Workflow Efficiency and Imaging Spectrum

Traditional hand-held ultrasonography (HHUS) suffers from inherent limitations, including operator dependency, lack of reproducibility, and long acquisition times in busy clinical settings. Automated breast ultrasound (ABUS) addresses these drawbacks by providing standardized, three-dimensional, and operator-independent imaging that separates acquisition from interpretation. While the diagnostic performance of ABUS has been extensively validated for supplemental screening in females with dense breast tissue, its specific application in the male population remains an unexplored frontier in the literature. Objective The objective of this study was to evaluate the diagnostic value, workflow advantages, and imaging spectrum of ABUS in male breast diseases based on a large-scale, single-center experience. Methods This retrospective study included 85 male patients (mean age: 36.6 ± 13.7 years) who underwent ABUS between April 2023 and February 2025. Inclusion criteria focused on symptomatic patients and those requiring high-risk screening or follow-up. Recall rates, complementary imaging frequency, and the Breast Imaging Reporting and Data System or BI-RADS categories were analyzed. Results Breast pain (53 cases, 62.4%) was the most common symptom, and gynecomastia (29 cases, 34.1%) was the most frequent finding. The recall rate for secondary HHUS was 1.2% (1 case). Three biopsies revealed one lipoma, one invasive ductal carcinoma, and one papillary carcinoma. Conclusion ABUS provides a standardized, reproducible evaluation of male breast diseases with minimal recall and optimized workflow efficiency. It serves as a promising adjunct to standard imaging protocols, particularly in younger males where avoiding radiation is preferable, and offers a unique anatomical plane (C-plane).