Benefits of digital breast tomosynthesis: A lesion-level analysis

2020 ◽  
pp. 096914132097826
Author(s):  
Tali Amir ◽  
Emily B Ambinder ◽  
Susan C Harvey ◽  
Eniola T Oluyemi ◽  
Mary K Jones ◽  
...  
Keyword(s):  
Digital Breast Tomosynthesis ◽  
Recall Rate ◽  
Architectural Distortion ◽  
Screening Mammogram ◽  
Diagnostic Challenge ◽  
Breast Tomosynthesis ◽  
Full Field ◽  
Lesion Type ◽  
Lesion Level ◽  
Screening Mammograms

Objective To compare outcome metrics of digital breast tomosynthesis (DBT) breast cancer screening with full-field digital mammogram (FFDM); specifically, to compare recall rates by the type of recalled finding, and to assess if screening with DBT versus FFDM changes biopsy recommendations and if the likelihood of malignancy varied by lesion type, if detected on DBT or FFDM screening mammogram. Methods The outcomes of 22,055 FFDM and DBT screening mammograms were retrospectively reviewed. The exams were performed at an academic institution between August 2015 and September 2016. Performance of screening with FFDM versus DBT was compared in terms of recall rate and percentage of recalled lesions resulting in a cancer diagnosis, with subset analyses performed for specific mammographic findings. Results The recall rate was 10.6% for FFDM and 8.0% for DBT ( p < 0.001). Architectural distortion was more likely to be recalled on DBT screening than FFDM ( p = 0.002), and was associated with an increased likelihood of malignancy ( p = 0.008). Asymmetries were less likely to be recalled on DBT than FFDM ( p < 0.001) screening mammogram, but more likely to be recommended for biopsy when detected on DBT. Calcifications more frequently required short-term follow-up or biopsy on both DBT and FFDM. Conclusions DBT screening confers an advantage in detection of architectural distortion representing malignancy. Recall rate of asymmetries are reduced with screening DBT, probably due to reduction of tissue superimposition. Calcifications pose a particularly difficult diagnostic challenge for breast imagers, regardless of screening mammogram type.

scholarly journals Diagnostic accuracy of digital breast tomosynthesis in combination with 2D mammography for the characterisation of mammographic abnormalities

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Vithya Visalatchi Sanmugasiva ◽  
Marlina Tanty Ramli Hamid ◽  
Farhana Fadzli ◽  
Faizatul Izza Rozalli ◽  
Chai Hong Yeong ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Breast Imaging ◽  
Digital Breast Tomosynthesis ◽  
Asian Population ◽  
Architectural Distortion ◽  
Breast Lesions ◽  
Cross Sectional ◽  
Breast Tomosynthesis ◽  
Full Field

AbstractThis study aims to assess the diagnostic accuracy of digital breast tomosynthesis in combination with full field digital mammography (DBT + FFDM) in the charaterisation of Breast Imaging-reporting and Data System (BI-RADS) category 3, 4 and 5 lesions. Retrospective cross-sectional study of 390 patients with BI-RADS 3, 4 and 5 mammography with available histopathology examination results were recruited from in a single center of a multi-ethnic Asian population. 2 readers independently reported the FFDM and DBT images and classified lesions detected (mass, calcifications, asymmetric density and architectural distortion) based on American College of Radiology-BI-RADS lexicon. Of the 390 patients recruited, 182 malignancies were reported. Positive predictive value (PPV) of cancer was 46.7%. The PPV in BI-RADS 4a, 4b, 4c and 5 were 6.0%, 38.3%, 68.9%, and 93.1%, respectively. Among all the cancers, 76% presented as masses, 4% as calcifications and 20% as asymmetry. An additional of 4% of cancers were detected on ultrasound. The sensitivity, specificity, PPV and NPV of mass lesions detected on DBT + FFDM were 93.8%, 85.1%, 88.8% and 91.5%, respectively. The PPV for calcification is 61.6% and asymmetry is 60.7%. 81.6% of cancer detected were invasive and 13.3% were in-situ type. Our study showed that DBT is proven to be an effective tool in the diagnosis and characterization of breast lesions and supports the current body of literature that states that integrating DBT to FFDM allows good characterization of breast lesions and accurate diagnosis of cancer.

scholarly journals Screening Digital Breast Tomosynthesis: Radiation Dose Among Patients With Breast Implants

2021 ◽  
Author(s):  
Nhu Q Vu ◽  
Curran Bice ◽  
John Garrett ◽  
Colin Longhurst ◽  
Daryn Belden ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Cancer Detection ◽  
Digital Breast Tomosynthesis ◽  
Breast Implants ◽  
Recall Rate ◽  
Screening Mammography ◽  
Chi Square ◽  
Breast Tomosynthesis ◽  
Full Field ◽  
Significant Difference

Abstract Objective To compare the mean glandular dose (MGD), cancer detection rate (CDR), and recall rate (RR) among screening examinations of patients with breast implants utilizing various digital breast tomosynthesis (DBT)-based imaging protocols. Methods This IRB-approved retrospective study included 1998 women with breast implants who presented for screening mammography between December 10, 2013 and May 29, 2020. Images were obtained using various protocol combinations of DBT and 2D digital mammography. Data collected included MGD, implant type and position, breast density, BI-RADS final assessment category, CDR, and RR. Statistical analysis utilized type II analysis of variance and the chi-square test. Results The highest MGD was observed in the DBT only protocol, while the 2D only protocol had the lowest (10.29 mGy vs 5.88 mGy, respectively). Statistically significant difference in MGD was observed across protocols (P &lt; 0.0001). The highest per-view MGD was among DBT full-field (FF) views in both craniocaudal and mediolateral oblique projections (P &lt; 0.0001). No significant difference was observed in RR among protocols (P = 0.17). The combined 2D (FF only) + DBT implant-displaced (ID) views protocol detected the highest number of cancers (CDR, 7.2 per 1000), but this was not significantly different across protocols (P = 0.48). Conclusion The combination of 2D FF views and DBT ID views should be considered for women with breast implants in a DBT-based screening practice when aiming to minimize radiation exposure without compromising the sensitivity of cancer detection. Avoidance of DBT FF in this patient population is recommended to minimize radiation dose.

scholarly journals Initial Experience with Combination Digital Breast Tomosynthesis Plus Full Field Digital Mammography or Full Field Digital Mammography Alone in the Screening Environment

2014 ◽  
Vol 4 ◽  
pp. 9 ◽  
Author(s):  
Stamatia Destounis ◽  
Andrea Arieno ◽  
Renee Morgan
Keyword(s):  
Breast Cancer ◽  
Digital Mammography ◽  
Digital Breast Tomosynthesis ◽  
Recall Rate ◽  
Screening Mammography ◽  
Breast Tomosynthesis ◽  
Full Field ◽  
Full Field Digital Mammography ◽  
Significant Difference ◽  
History Of

Objectives: Initial review of patients undergoing screening mammography imaged with a combination of digital breast tomosynthesis (DBT) plus full field digital mammography (FFDM) compared with FFDM alone. Materials and Methods: From June 2011 to December 2011, all patients presenting for routine screening mammography were offered a combination DBT plus FFDM exam. Under institutional review board approval, we reviewed 524 patients who opted for combination DBT plus FFDM and selected a sample group of 524 FFDM screening exams from the same time period for a comparative analysis. The χ2 (Chi-square) test was used to compare recall rates, breast density, personal history of breast cancer, and family history of breast cancer between the two groups. Results: Recall rate for FFDM, 11.45%, was significantly higher (P < 0001) than in the combination DBT plus FFDM group (4.20%). The biopsy rate in the FFDM group was 2.29% (12/524), with a cancer detection rate of 0.38% (2/524, or 3.8 per 1000) and positive predictive value (PPV) of 16.7% (2/12). The biopsy rate for the DBT plus FFDM group was 1.14% (n = 6/524), with a cancer detection rate 0.57% (n = 3/524, or 5.7 per 1000) and PPV of 50.0% (n = 3/6). Personal history of breast cancer in the FFDM group was significantly lower (P < 0.0001) than in the combination DBT plus FFDM group; 2.5% and 5.7%, respectively. A significant difference in family history of breast cancer (P < 0.0001) was found, with a higher rate in the combination DBT plus FFDM group (36.0% vs. 53.8%). There was a significant difference between the combination DBT plus FFDM group and FFDM alone group, when comparing breast density (P < 0.0147, 61.64% vs. 54.20% dense breasts, respectively) with a higher rate of dense breasts in the DBT plus FFDM group. In follow-up, one cancer was detected within one year of normal screening mammogram in the combination DBT plus FFDM group. Conclusion: Our initial experience found the recall rate in the combination DBT plus FFDM group was significantly lower than in the FFDM alone group, despite the fact that the combination DBT plus FFDM group had additional risk factors.

DETECTION OF BREAST CANCERS REPRESENTED AS ARCHITECTURAL DISTORTION: A COMPARISON OF FULL-FIELD DIGITAL MAMMOGRAPHY AND DIGITAL BREAST TOMOSYNTHESIS

2021 ◽  
Vol 74 (7) ◽  
pp. 1674-1679
Author(s):  
Tetiana M. Babkina ◽  
Andrii V. Gurando ◽  
Tetiana M. Kozarenko ◽  
Viacheslav R. Gurando ◽  
Vadim V. Telniy ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Digital Mammography ◽  
Digital Breast Tomosynthesis ◽  
Architectural Distortion ◽  
Breast Cancers ◽  
Breast Tomosynthesis ◽  
Full Field ◽  
Full Field Digital Mammography ◽  
Ductal Hyperplasia ◽  
History Of

The aim: The aim of our study was to determine if digital breast tomosynthesis improves breast cancer detection associated with architectural distortion in comparison with full-field digital mammography in the absence of appropriate history of trauma or surgery. Materials and methods: The overall rate of breast cancer involvement for the 34 patients with architectural distortion was 15 cases (44,1%) (invasive breast cancers, n=12 (36,4%); ductal cancer in situ, n= 3 (8,8%)) other findings associated with architectural distortion were high-risk lesions and benign findings (radial scar, n=5 (14,7%); sclerosing adenosis, n=9 (26,5%); typical lobular hyperplasia, n=3 (8,8%); typical ductal hyperplasia, n=2 cases (5,9%)). Results: Overall of 17/34 (50.0%) architectural distortions were identified at digital breast tomosynthesis that were missed at full-field digital mammography what was statistically significant difference ([95% CI, 2.56–7.45]; p=0.00001). Analysis of the results showed that sensitivity of full-field digital mammography for digital breast tomosynthesis detected breast cancers associated with architectural distortion was 53.3% [95% CI, 26.59% to 78.73%] and specificity was 52.63% [95% CI, 28.86% to 75.55%]. Conclusions: Our study suggests that digital breast tomosynthesis detects more breast cancers represented as architectural distortion which are occult on full-field digital mammography. Presence of microcalcifications within architectural distortion, in the absence of appropriate history of trauma or surgery, has a high likelihood of malignancy and obligatorily requires biopsy.

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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