Can Digital Breast Tomosynthesis Solve the Challenge of Dense Breast                     Parenchyma?

Background: Digital mammography (DM) is one of the most common and effective radiological methods for breast cancer screening and detection. A dense fibroglandular breast tissue can lead to false negative results by superimposing on the lesion margins. Therefore, adjunctive imaging methods, such as digital breast tomosynthesis (DBT) and ultrasonography (US), are needed to increase mammographic sensitivity. Objectives: This study aimed to examine the contribution of US and DBT to DM in different patient groups (patients group of BI-RADS 0 and 3-4 lesions, patients with dense breast parenchyma, patients with non-dense breast parenchyma).. Whether US and DBT can upgrade or downgrade the BI-RADS category of uncertain lesions detected on DM was also investigated. Patients and Methods: Forty-six patients, who were classified as BI-RADS categories 0, 3, and 4 in DM, according to DBT and US findings, were included in the study. DM followed by DBT was performed for the patients, and the BI-RADS classification system was applied. Subsequently, the patients were evaluated sonographically, and the BI-RADS system was applied according to the US results. Each BI-RADS category was compared with the histopathological and multimodality follow-up results. The diagnostic performance of all modalities was also examined alone and in combination. Results: The sensitivity and specificity of DM alone was 42% and 87%, respectively. DBT detected the lesions with 92% sensitivity and 68% specificity. The modality with the highest sensitivity for the detection of malignant lesions was US (100%). Besides, the specificity of DBT was significantly high for dense breasts (P < 0.001). There was no significant difference in terms of the diagnostic accuracy of US measurements between dense and non-dense breasts. For indeterminate lesions, the integration of DBT and US to DM increased the diagnostic accuracy. Conclusion: The contribution of DBT is more valuable than US in patients with dense breast parenchyma.

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Dense Breast Ultrasound Screening After Digital Mammography Versus After Digital Breast Tomosynthesis

American Journal of Roentgenology ◽

10.2214/ajr.18.20748 ◽

2019 ◽

Vol 213 (6) ◽

pp. 1397-1402 ◽

Cited By ~ 3

Author(s):

Elizabeth H. Dibble ◽

Tisha M. Singer ◽

Nneka Jimoh ◽

Grayson L. Baird ◽

Ana P. Lourenco

Keyword(s):

Digital Mammography ◽

Digital Breast Tomosynthesis ◽

Breast Ultrasound ◽

Dense Breast ◽

Ultrasound Screening ◽

Breast Tomosynthesis

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Power Spectrum Analysis of Breast Parenchyma with Digital Breast Tomosynthesis Images in a Longitudinal Screening Cohort from Two Vendors

Academic Radiology ◽

10.1016/j.acra.2021.08.014 ◽

2021 ◽

Author(s):

Kai Yang ◽

Craig K Abbey ◽

Shinn-Huey Shirley Chou ◽

Brian N Dontchos ◽

Xinhua Li ◽

...

Keyword(s):

Power Spectrum ◽

Spectrum Analysis ◽

Digital Breast Tomosynthesis ◽

Power Spectrum Analysis ◽

Breast Tomosynthesis ◽

Breast Parenchyma

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The Diagnostic Performance of Wide-Angle Digital Breast Tomosynthesis in Comparison to Hand-Held 2D Ultrasound in the Evaluation of Probably Benign & Malignant Lesions in Dense Breast Parenchyma

Tumori Journal ◽

10.1177/0300891620914165 ◽

2020 ◽

Vol 106 (1_suppl) ◽

pp. 33-33

Author(s):

I. Ewais ◽

A. Awis ◽

Y. Fahim ◽

S. Khodair ◽

H. Gewefel

Keyword(s):

Diagnostic Performance ◽

Digital Breast Tomosynthesis ◽

Dense Breast ◽

Architectural Distortion ◽

Wide Angle ◽

Benign Lesions ◽

Breast Tomosynthesis ◽

Dense Breasts ◽

Negative Results ◽

Malignant Lesions

Background: Imaging of dense breast represents a diagnostic challenge for interpreting radiologists. Tomosynthesis and ultrasound are used as additional imaging tools to compensate the lower sensitivity of 2D mammography when examining a dense breast. This study compares the diagnostic performance of 50° wide-angle digital breast tomosynthesis (wide-angle DBT) to hand-held breast ultrasound (HHUS) in the evaluation of probably benign and malignant breast lesions in dense breast. Patients and Methods: A retrospective review of 131 women with dense breasts (ACR C and D) was conducted during a 12-months period (October 2018 -October 2019). Out of the 131 women; 40 cases (30.5%) were reported to have 64 probably benign and malignant lesions (BI-RADS 3, 4 and 5) detected by combined wide-angle DBT and HHUS. Patients with negative results (BI-RADS 1) or typically benign lesions (BI-RADS 2) were excluded from this study. Median age for the included 40 cases=46.8 years (range =30-67). Women above the age of 40 (n=35, 87%) were examined with combined 2D mammogram + wide-angle DBT and ultrasound. Women below 40 (n=5, 13%) were initially examined by ultrasound and obtained complementary wide-angle DBT mammography based on clinical necessity. Separate BI-RADS were given for each modality and independently correlated with histopathological results for BI-RADS 4 and 5, or routine follow up images for BI-RADS 3. Results: Among the 64 lesions; 10 (15.6%) were pathologically proven malignant in 5 cases (two cases were presenting with multi-focal disease), and 54 (84.4%) benign lesions pathologically proven or followed up in 35 patients. Sensitivity was 100% for wide-angle DBT (10/10) and 80% for ultrasound (8/10). Specificity and positive predictive value for ultrasound was 94.4% (51/54) and 72.7% (8/11), respectively. For wide-angle DBT, specificity was 90.7% (49/54) and positive predictive value was 66.7% (10/15). Despite the high sensitivity, in our study, DBT showed equal diagnostic accuracy to that of breast ultrasound (92.2%, 59/64). Both modalities were not similar in depicting malignant lesions; two more lesions were initially identified at wide-angle DBT images presented as <1cm area of architectural distortion (p=0.07). Other two diagnostic cases presented with acute inflammatory symptoms; they showed architectural distortion in DBT, which were false-positives for the later, yet, ultrasound showed mastitis and abscess formation. Ultrasound significantly identified more benign lesions than DBT mammography (p=0.001). Conclusion: Wide-angle DBT and HHUS are indispensable in identifying probably benign and malignant lesions in dense breasts. Our study showed the role of Wide-angle DBT in detecting small (<1 cm) malignant lesions presenting as architectural distortion. However, the radiologists experience with DBT and the significant clinical information added by ultrasound may impact the diagnostic performance. Therefore, supplemental HHUS to wide-angle DBT will increase accuracy and true negative results for a lower benign biopsy rate.

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