Use of single-view digital breast tomosynthesis (DBT) and ultrasound vs. additional views and ultrasound for the assessment of screen-detected abnormalities: German multi-reader study

2017 ◽  
Vol 59 (7) ◽  
pp. 782-788 ◽  
Author(s):  
Sylvia H Heywang-Köbrunner ◽  
Astrid Hacker ◽  
Alexander Jänsch ◽  
Ronald Kates ◽  
Sabina Wulz-Horber ◽  
...  
Keyword(s):  
Random Sequence ◽  
Digital Breast Tomosynthesis ◽  
Region Of Interest ◽  
Screening Mammography ◽  
Breast Tomosynthesis ◽  
Single View ◽  
Lower Specificity ◽  
Malignant Lesions ◽  
Tissue Abnormalities

Background Data on the value of digital breast tomosynthesis (DBT) for further assessment of screen-detected lesions are still limited. Purpose To compare screening mammography, single-view DBT and ultrasound-information (TS) vs. screening mammography, additional views and ultrasound-information (AV) for assessment of screen-detected abnormalities. Material and Methods The use of wide-angle DBT for screen-detected, soft-tissue abnormalities requiring additional views was investigated: 241 cases (206 benign and 35 malignant lesions), verified by histology or two-year follow-up, were read by ten readers as TS and as AV sets, yielding 2410 diagnoses for each set. Readings were randomly sequenced. Results The mean interval between readings was nine weeks (random sequence). Evaluation was breast-based. Overall, in terms of area under receiver operating characteristic (AUC; varying degree of suspicion cutoff), TS and AV readings showed similar performance: for TS, AUC was 0.889 (95% confidence interval [CI] = 0.871–0.907) and for AV, AUC was 0.903 (95% CI = 0.886–0.921). TS readings had slightly higher sensitivity than AV readings (96.9% vs. 95.4%) but lower specificity (50% vs. 58.1%) and more variations between reader performance; absolute false negatives (FN) were reduced in 8/16 readers, equal in 5/16, and increased in only 3/16. Conclusion This study broadly confirms previous data showing equivalence of DBT to AV. However, bias against TS may have occurred since the region of interest was not indicated in the TS set as compared to its obvious identification on the AV set by the selected spot views. A key finding is that reader experience with DBT may be more important than so far reported.

scholarly journals Value of Digital Breast Tomosynthesis versus Additional Views for the Assessment of Screen-Detected Abnormalities - a First Analysis

Breast Care ◽  
2017 ◽  
Vol 12 (2) ◽  
pp. 91-96 ◽  
Author(s):  
Sylvia Heywang-Köbrunner ◽  
Alexander Jaensch ◽  
Astrid Hacker ◽  
Sabina Wulz-Horber ◽  
Thomas Mertelmeier ◽  
...  
Keyword(s):  
Digital Breast Tomosynthesis ◽  
Ethics Committee ◽  
Wide Angle ◽  
Breast Tomosynthesis ◽  
Single View ◽  
Extra Information ◽  
Standard Assessment ◽  
Sensitivity Specificity ◽  
Blinded Reader

Background: The purpose of this study was to countercheck the equivalence of single-view digital breast tomosynthesis (DBT) or DBT with additional views (DBT+AV) compared to traditional standard assessment by additional views (AV) in patients with a screen-detected abnormality. Patients and Methods: Patients with a screen-detected abnormality were consecutively invited to obtain 1 single-view wide-angle DBT in addition to the indicated AV. The study was approved by the local ethics committee and by the Federal Office for Radiation Protection. Results: This study is based on 311 lesions in 285 patients with a follow-up of > 2 years and/or biopsy. Counting BI-RADS 0 and 3 as positive calls, the sensitivity/specificity of DBT+AV versus DBT only versus AV only were 96.4/54.3%, 96.4/56.6%, and 90.9/42.2%, respectively. The specificities and BI-RADS classifications differed significantly (p < 0.01). AV appeared unnecessary in 88.8% of the cases. Conclusion: DBT appeared to be at least equivalent to AV for assessing indeterminate screen-detected lesions and could replace AV for most lesions. To obtain the extra information appears possible without increasing the overall radiation dose. Subsequent blinded reader studies are ongoing.

Breast tomosynthesis for the clarification of mammographic BI-RADS 3 lesions can decrease follow-up examinations and enables immediate cancer diagnosis

2018 ◽  
Vol 59 (10) ◽  
pp. 1176-1183 ◽  
Author(s):  
Sonja D Bahrs ◽  
Vanessa Otto ◽  
Valerie Hattermann ◽  
Bernhard Klumpp ◽  
Markus Hahn ◽  
...  
Keyword(s):  
Intraclass Correlation ◽  
False Negative ◽  
Digital Breast Tomosynthesis ◽  
Recall Rate ◽  
Breast Tomosynthesis ◽  
Malignant Lesions ◽  
Reader Reliability ◽  
Histological Result ◽  
Good Agreement

Background The limited sensitivity of mammography in case of a high breast density often produces unclear or false-positive findings, so-called BI-RADS 3 lesions, which have to be followed up to prove benignity. Digital breast tomosynthesis (DBT) was developed to reduce such summation effects. Purpose To evaluate the influence of an additional DBT on the management of mammographic BI-RADS 3 findings and whether DBT can decrease the time to definitive diagnosis or not. Material and Methods We analyzed 87 patients with a mammographic non-calcified BI-RADS 3 lesion who underwent an additional DBT of the affected breast. A follow-up two-dimensional (2D) examination or a histological result of the lesion had to be available. The images were analyzed especially for the BI-RADS category and incremental diagnostic accuracy. Moreover, the inter-reader reliability and the radiation dose were evaluated. Results The BI-RADS category has been changed by the addition of DBT: 57.1% were assessed as BI-RADS 1 or 2, 4.6% as BI-RADS 4, and only 38.3% remained as BI-RADS 3. The intraclass correlation coefficient for the three readers showed a good agreement for inter-reader reliability. No false-negative examination was found in the follow-ups. Nine lesions were biopsied (seven benign, two malignant). Both malignant lesions were suspicious in the DBT (BI-RADS 4). A significant higher glandular dose was necessary for the DBT. Conclusion DBT has the potential to reduce the recall-rate of BI-RADS 3 lesions and to find and diagnose malignant lesions earlier than 2D mammography alone.

Digital Breast Tomosynthesis: Initial Experience in 98 Women with Abnormal Digital Screening Mammography

2007 ◽  
Vol 189 (3) ◽  
pp. 616-623 ◽  
Author(s):  
Steven P. Poplack ◽  
Tor D. Tosteson ◽  
Christine A. Kogel ◽  
Helene M. Nagy
Keyword(s):  
Digital Breast Tomosynthesis ◽  
Screening Mammography ◽  
Initial Experience ◽  
Breast Tomosynthesis

Screening Mammography and Digital Breast Tomosynthesis: Utilization Updates

2018 ◽  
Vol 210 (5) ◽  
pp. 1092-1096 ◽  
Author(s):  
Gilda Boroumand ◽  
Ida Teberian ◽  
Laurence Parker ◽  
Vijay M. Rao ◽  
David C. Levin
Keyword(s):  
Digital Breast Tomosynthesis ◽  
Screening Mammography ◽  
Breast Tomosynthesis

scholarly journals The value of mammography in women with focal breast complaints in addition to initial targeted ultrasound

2020 ◽  
Author(s):  
L. Appelman ◽  
P. T. M. Appelman ◽  
C. C. N. Siebers ◽  
P. Bult ◽  
H. L. S. Go ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Imaging ◽  
Digital Breast Tomosynthesis ◽  
Breast Disease ◽  
Added Value ◽  
Breast Tomosynthesis ◽  
Targeted Ultrasound ◽  
Symptomatic Breast Cancer ◽  
Symptomatic Breast

Abstract Purpose To determine the added value of mammography in women with focal breast complaints and the utility of initial targeted ultrasound in this setting. Methods Women with symptomatic breast disease who were evaluated by breast imaging (mammography/digital breast tomosynthesis and ultrasound) between January 2016 and December 2016 in the Radboud University Medical Centre were included. We retrospectively collected the following data: date of birth, indication of imaging, visibility on mammography/ultrasound, whether biopsy was taken, additional findings, BI-RADS-classification, pathology and follow-up results. Results A total of 494 women were included (mean age 46.5, range 30 to 93). In 49 women (9.9%), symptomatic breast cancer was diagnosed, all visible during targeted ultrasound. The negative predictive value of targeted ultrasound was very high (99.8%). Additional findings on mammography were significantly more often malignant when the symptomatic lesion was also malignant (3.8% vs 70%, P < 0.05). In only one patient with symptoms caused by a benign finding, an incidental malignancy was detected on mammography outside the area of complaint (detection rate 2.2/1000 examinations). Conclusions The contribution of mammography for cancer detection in women with focal breast complaints is very low when targeted ultrasound is performed. Additional findings are most common in patients with symptomatic breast cancer. Our results suggest that initial targeted ultrasound is a more appropriate initial tool for the evaluation of focal breast complaints. Mammography could be performed on indication only.

Architectural Distortion on Digital Breast Tomosynthesis: Management Algorithm and Pathological Outcome

2020 ◽  
Vol 2 (5) ◽  
pp. 424-435
Author(s):  
Naziya Samreen ◽  
Linda Moy ◽  
Cindy S Lee
Keyword(s):  
Digital Mammography ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Digital Breast Tomosynthesis ◽  
Percutaneous Biopsy ◽  
Architectural Distortion ◽  
Imaging Findings ◽  
Breast Tomosynthesis ◽  
Management Algorithm

Abstract Architectural distortion on digital breast tomosynthesis (DBT) can occur due to benign and malignant causes. With DBT, there is an increase in the detection of architectural distortion compared with 2D digital mammography, and the positive predictive value is high enough to justify tissue sampling when imaging findings are confirmed. Workup involves supplemental DBT views and ultrasound, with subsequent image-guided percutaneous biopsy using the modality on which it is best visualized. If architectural distortion is subtle and/or questionable on diagnostic imaging, MRI may be performed for problem solving, with subsequent biopsy of suspicious findings using MRI or DBT guidance, respectively. If no suspicious findings are noted on MRI, a six-month follow-up DBT may be performed. On pathology, malignant cases are noted in 6.8%–50.7% of the cases, most commonly due to invasive ductal carcinoma, followed by invasive lobular carcinoma. Radial scars are the most common benign cause, with stromal fibrosis and sclerosing adenosis being much less common. As there is an increase in the number of benign pathological outcomes for architectural distortion on DBT compared with 2D digital mammography, concordance should be based on the level of suspicion of imaging findings. As discordant cases have upgrade rates of up to 25%, surgical consultation is recommended for discordant radiologic-pathologic findings.

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