Issues to Consider Before Implementing Digital Breast Tomosynthesis Into a Breast Imaging Practice

Digital breast tomosynthesis (DBT) studies were introduced as a successful help for the detection of calcification, which can be a primary sign of cancer. Expert radiologists are able to detect suspicious calcifications in DBT, but a high number of calcifications with non-malignant diagnosis at biopsy have been reported (false positives, FP). In this study, a radiomic approach was developed and applied on DBT images with the aim to reduce the number of benign calcifications addressed to biopsy and to give the radiologists a helpful decision support system during their diagnostic activity. This allows personalizing patient management on the basis of personalized risk. For this purpose, 49 patients showing microcalcifications on DBT images were retrospectively included, classified by BI-RADS (Breast Imaging-Reporting and Data System) and analyzed. After segmentation of microcalcifications from DBT images, radiomic features were extracted. Features were then selected with respect to their stability within different segmentations and their repeatability in test–retest studies. Stable radiomic features were used to train, validate and test (nested 10-fold cross-validation) a preliminary machine learning radiomic classifier that, combined with BI-RADS classification, allowed a reduction in FP of a factor of 2 and an improvement in positive predictive value of 50%.

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Computer-Aided Detection and Diagnosis for 3D X-Ray Based Breast Imaging

Machine Learning in Computer-Aided Diagnosis - Advances in Bioinformatics and Biomedical Engineering ◽

10.4018/978-1-4666-0059-1.ch003 ◽

2012 ◽

pp. 66-85

Author(s):

Gautam S. Muralidhar ◽

Alan C. Bovik ◽

Mia K. Markey

Keyword(s):

Breast Imaging ◽

Digital Breast Tomosynthesis ◽

Future Research ◽

Computer Aided Detection ◽

Breast Tomosynthesis ◽

X Ray ◽

Computer Aided ◽

Recent Developments ◽

Initial Work ◽

Detection And Diagnosis

The last 15 years has seen the advent of a variety of powerful 3D x-ray based breast imaging modalities such as digital breast tomosynthesis, digital breast computed tomography, and stereo mammography. These modalities promise to herald a new and exciting future for early detection and diagnosis of breast cancer. In this chapter, the authors review some of the recent developments in 3D x-ray based breast imaging. They also review some of the initial work in the area of computer-aided detection and diagnosis for 3D x-ray based breast imaging. The chapter concludes by discussing future research directions in 3D computer-aided detection.

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

Breast Cancer Research and Treatment ◽

10.1007/s10549-020-05943-5 ◽

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.

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

Scientific Reports ◽

10.1038/s41598-020-77456-6 ◽

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.

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Lobular Breast Cancer Conspicuity on Digital Breast Tomosynthesis Compared to Synthesized 2D Mammography: A Multireader Study

Journal of Imaging ◽

10.3390/jimaging7090185 ◽

2021 ◽

Vol 7 (9) ◽

pp. 185

Author(s):

Giovanna Romanucci ◽

Lisa Zantedeschi ◽

Anna Ventriglia ◽

Sara Mercogliano ◽

Maria Vittoria Bisighin ◽

...

Keyword(s):

Breast Cancer ◽

Breast Imaging ◽

Digital Breast Tomosynthesis ◽

Matched Pairs ◽

Breast Cancers ◽

Test Results ◽

Lobular Breast Cancer ◽

Point Scale ◽

Breast Tomosynthesis ◽

Invasive Lobular Breast Cancer

Objectives: To compare the conspicuity of lobular breast cancers at digital breast tomosynthesis (DBT) versus synthesized 2D mammography (synt2D). Materials and methods: Seventy-six women (mean age 61.2 years, range 50–74 years) submitted to biopsy in our institution, from 2019 to 2021, with proven invasive lobular breast cancer (ILC) were enrolled in this retrospective study. The participants underwent DBT and synt2D. Five breast radiologists, with different years of experience in breast imaging, independently assigned a conspicuity score (ordinal 6-point scale) to DBT and synt2D. Lesion conspicuity was compared, for each reader, between the synt2D overall conspicuity interpretation and DBT overall conspicuity interpretation using a Wilcoxon matched pairs test. Results: A total of 50/78 (64%) cancers were detected on both synt2D and DBT by all the readers, while 28/78 (26%) cancers where not recognized by at least one reader on synt2D. For each reader, in comparison with synt2D, DBT increased significantly the conspicuity of ILC (p < 0.0001). The raw proportion of high versus low conspicuity by modality confirmed that cancers were more likely to have high conspicuity at DBT than synt2D. Conclusions: ILCs were more likely to have high conspicuity at DBT than at synt2D, increasing the chances of the detection of ILC breast cancer.

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Pros and cons for breast cancer screening with tomosynthesis – a review of the

Medicine and Pharmacy Reports ◽

10.15386/mpr-1698 ◽

2020 ◽

Author(s):

Julian Hans Kleinknecht ◽

Anca Ileana Ciurea ◽

Cristiana Augusta Ciortea

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Breast Imaging ◽

Digital Breast Tomosynthesis ◽

Detection Rates ◽

Breast Tomosynthesis ◽

Screening Programs ◽

Long Term Follow Up ◽

Imaging Research

Breast cancer screening programs using mammography proved their value in detecting breast cancer at early stages and, consequently, reducing the mortality from this disease. Due to the technological progress, the screening programs have shifted from screen-film mammography to digital mammography and nowadays digital breast tomosynthesis became the focus of breast imaging research. Using tomosynthesis in screening increases cancer detection rates and decreases recall and false-positive rates, thus improving the effectiveness of breast cancer screening programs, with positive consequences on health care costs and on patient psychology. More long-term follow-up data must be collected for assessing absolute sensitivity and specificity of digital breast tomosynthesis, together with efforts for addressing the limitations of the method.

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A new breast tomosynthesis imaging method: Continuous Sync-and-Shoot – technical feasibility and initial experience

Acta Radiologica Open ◽

10.1177/2058460119836255 ◽

2019 ◽

Vol 8 (3) ◽

pp. 205846011983625

Author(s):

Mikko O Jousi ◽

Jukka Erkkilä ◽

Mari Varjonen ◽

Martti Soiva ◽

Katja Hukkinen ◽

...

Keyword(s):

Breast Imaging ◽

Digital Breast Tomosynthesis ◽

Imaging Method ◽

Image Evaluation ◽

Breast Tomosynthesis ◽

Shoot Method ◽

Imaging Parameters ◽

Image Pairs ◽

Test Patient ◽

Better Than

Background Digital breast tomosynthesis (DBT) is gaining popularity in breast imaging. There are several different technical approaches for conducting DBT imaging. Purpose To determine optimal imaging parameters, test patient friendliness, evaluate the initial diagnostic performance, and describe diagnostic advances possible with the new Continuous Sync-and-Shoot method. Material and Methods Thirty-six surgical breast specimens were imaged with digital mammography (DM) and a prototype of a DBT system (Planmed Oy, Helsinki, Finland). We tested the patient friendliness of the sync-and-shoot movement without radiation exposure in eight volunteers. Different imaging parameters were tested with 20 specimens to identify the optimal combination: angular range 30°, 40°, and 60°; pixel binning; Rhodium (Rh) and Silver (Ag) filtrations; and different kV and mAs values. Two breast radiologists evaluated 16 DM and DBT image pairs and rated six different image properties. Imaging modalities were compared with paired t-test. Results The Continuous Sync-and-Shoot method produced diagnostically valid images. Five out of eight volunteers felt no/minimal discomfort, three experienced mild discomfort from the tilting movement of the detector, with the motion being barely recognized. The combination of 30°, Ag filtering, and 2 × 2 pixel binning produced the best image quality at an acceptable dose level. DBT was significantly better in all six evaluated properties ( P < 0.05). Mean DoseDBT/DoseDM ratio was 1.22 (SD = 0.42). Conclusion The evaluated imaging method is feasible for imaging and analysing surgical breast specimens and DBT is significantly better than DM in image evaluation.

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Lesion Localization Using Digital Breast Tomosynthesis: Where Did I Go Wrong?

Journal of Breast Imaging ◽

10.1093/jbi/wbz009 ◽

2019 ◽

Vol 1 (2) ◽

pp. 143-150

Author(s):

Dipti Gupta ◽

Sarah M Friedewald

Keyword(s):

Breast Imaging ◽

Breast Tissue ◽

Digital Breast Tomosynthesis ◽

Diagnostic Tools ◽

Location Prediction ◽

Anterior Portion ◽

Breast Tomosynthesis ◽

Lesion Location ◽

Lesion Localization ◽

Diagnostic Setting

Abstract The scroll bar on digital breast tomosynthesis has become an imperative tool that breast imaging radiologists rely on for help in identify lesions on the orthogonal view, targeting breast ultrasound, and performing challenging biopsies for one-view findings. The ability to predict the lesion location using the scroll bar not only saves time in the diagnostic setting but also reduces screening recalls when a finding can be confirmed as dermal. It is important, however, to recognize settings in which the location prediction can be misleading, such as for lesions in thin breast tissue or the anterior portion of the breast or if the breast is not appropriately positioned. In these situations, radiologists can use other diagnostic tools for problem solving.

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Comparison of Call-Back Rates between Digital Mammography and Digital Breast Tomosynthesis

The American Surgeon ◽

10.1177/000313481908500837 ◽

2019 ◽

Vol 85 (8) ◽

pp. 855-857

Author(s):

Anthony M. Scott ◽

Madison G. Lashley ◽

Nicholas B. Drury ◽

Paul S. Dale

Keyword(s):

Breast Cancer ◽

Ultrasound Imaging ◽

Digital Mammography ◽

Breast Imaging ◽

Digital Breast Tomosynthesis ◽

Data System ◽

Screening Tools ◽

Radiographic Imaging ◽

Breast Cancers ◽

Breast Tomosynthesis

The effect of mammographic screening on the natural history and evolution of breast cancer treatment cannot be overstated; however, despite intensive and resource consuming screening, advanced breast cancer is still diagnosed frequently. The development of three-dimensional mammography or digital breast tomosynthesis (DBT) has already demonstrated greater sensitivity in the diagnosis of breast pathology and effectiveness in identifying early breast cancers. In addition to being a more sensitive screening tool, other studies indicate DBT has a lower call-back rate when compared with traditional DM. This study compares call-back rates between these two screening tools. A single institution, retrospective review was conducted of almost 20,000 patient records who underwent digital mammography or DBTin the years 2016 to 2018. These charts were analyzed for documentation of imaging type, Breast Imaging Reporting and Data System 0 status, call-back status, and type of further imaging that was required. Charts for 19,863 patients were reviewed, 17,899 digital mammography examinations were conducted compared with 11,331 DBT examinations resulting in 1,066 and 689 Breast Imaging Reporting and Data System 0 studies, respectively. Of the DM call-backs, 82.08 per cent were recommended for additional radiographic imaging and 17.82 per cent for ultrasound imaging. In the DBT group, only 39.77 per cent of callbacks were recommended for additional radiographic imaging and 60.09 per cent for ultrasound imaging. Our data suggest that DBT results in less call-back for additional mammographic images as compared with digital mammography. DBT may offer benefits over DM, including less imaging before biopsy, less time before biopsy, quicker diagnosis, and improved patient satisfaction.

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Antecedents: A Half-Century of Imaging the Breast

Journal of Breast Imaging ◽

10.1093/jbi/wby016 ◽

2019 ◽

Vol 1 (1) ◽

pp. 2-8

Author(s):

Daniel B Kopans

Keyword(s):

Breast Cancer ◽

Magnetic Resonance ◽

Breast Imaging ◽

Death Rate ◽

Digital Breast Tomosynthesis ◽

Breast Cancers ◽

Breast Tomosynthesis ◽

Half Century ◽

X Ray ◽

Detect Breast Cancer

Abstract The field of Breast Imaging evolved because a fairly small number of dedicated individuals realized the lifesaving potential of detecting breast cancer earlier. They persevered despite persistent efforts to curtail screening. From the first attempts to produce X-ray images of the breast to magnetic resonance and digital breast tomosynthesis, investigators have worked continuously to develop better ways to detect breast cancer at a time when cure is possible, while working continuously to preserve access for women to screening. Consequently, the death rate from breast cancer has declined by more than 40%. Therapy has improved, but therapy saves lives when breast cancers are treated early.

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