RATIONALE AND OBJECTIVES: To assess how well radiologists visualize relevant features of lesions seen with automated breast volumetric scanning (ABVS) in comparison to hand-held breast ultrasound in women going to breast biopsy. MATERIALS AND METHODS: Twenty-five subjects were recruited from women who were scheduled to undergo a breast biopsy for at least one Breast Imaging-Reporting and Data System four or five lesion identified in a diagnostic setting. In this institutional review board-approved study, the subjects underwent imaging of the breast(s) of concern using a dedicated system that allowed both hand-held breast ultrasound and ABVS. Five experienced breast radiologists reviewed the 30 lesions in 25 subjects in a reader study. Each reader was asked to specify the lesion type, size, imaging features, Breast Imaging-Reporting and Data System, and suspicion of malignancy and to compare the lesion characteristics of shape and margins between the two modalities. RESULTS: Seven (23.3%) masses were malignant and 23 (76.4%) were benign. Across all lesions regardless of size or final pathology, there was no significant difference in sensitivity or specificity (P > .15) between the two modalities. For malignant lesions, the reader visualization confidence scores between the two ultrasound modalities were not significantly different (P > .1). However, analysis for nonmalignant cases showed a statistically significant increase in reader visualization confidence in lesion shape and margins (P < .001). CONCLUSIONS: Radiologists showed increased confidence in visualization of benign masses and equal confidence in suspicious masses with ABVS imaging. This information could help decrease the need for additional hand-held imaging after automated whole breast ultrasound.