We recently read with interest an article ‘Comparison of conventional and automated breast volume ultrasound in the description and characterization of solid breast masses based on BI-RADS features’ published in Breast Cancer (Tokyo, Japan) . First of all, we appreciate the authors’ endeavor towards the informative study of new ultrasound technique—automated breast volume ultrasound (ABVU). The purpose of the article was ‘to compare the performance of radiologists in the use of conventional ultrasound (US) and ABVU for the characterization and differential diagnosis of solid breast lesions’, which we tried to translate into three meanings through careful full-text review: (1) ‘compare the performance of ABVU and conventional US on any one breast lesion by each radiologist’ (we may call it ‘inter-test agreement’); (2) ‘different radiologists’ performance on any one lesion with the use of ABVU or conventional HHUS’ (‘inter-observer agreement of ABVU/conventional US’); (3) ‘different radiologists’ performance on any one lesion with the combination use of ABVU and conventional US’ (inter-observer agreement of ABVS?conventional US). The second meaning is particularly instructive to our current clinical work, which we fully expect the result of eliminating the diagnostic differences between different observers or overcoming the poor repeatability of conventional US. However, despite that the term ‘inter-observer agreement’ was repeated two times in the article, there is no evidenced data reflecting inter-observer agreement analysis. Then, we have some doubts: (1) In ‘Statistical analysis’, the author stated ‘the inter-observer agreement of the three radiologist for each US techniques were calculated’, but neither ‘the inter-observer agreement of ABVU’ nor ‘the inter-observer agreement of conventional US’ was provided in the descriptions or tables or figures in ‘Results’ or ‘Discussion’. (2) In ‘Conclusion’ of ‘Abstract’, the author used the phrase ‘substantial inter-observer agreement in the final assessment of solid breast masses by conventional US and ABVU’, which is not equivalent to ‘the agreement of conventional US and ABVU’ (inter-test agreement) or identical to ‘the interobserver agreement of ABVU/conventional US’, but refers to ‘inter-observer agreement of the combination use of the two techniques’ (inter-observer agreement of ABVS?conventional US). (3) In ‘Results’, ‘j = 0.773 ± 0.104’ in ‘Final assessment’ was clearly calculated through the average of three j values, that is, the average of three evaluations of ‘agreement of the two techniques’ by three radiologists. Therefore, the substantial agreement (j = 0.773 ± 0.104) actually stands for the ‘inter-test agreement’, rather than ‘interobserver agreement of the final assessment’. The other This comment refers to the article available at doi:10.1007/s12282012-0419-1.