Characterization of lesions in dense breasts: Does tomosynthesis help?

Abstract

Context:Mammography in dense breasts is challenging due to lesion obscuration by tissue overlap. Does tomosynthesis offers a solution?Aims:To study the impact of digital breast tomosynthesis (DBT) in characterizing lesions in breasts of different mammographic densities.Settings and Design:Prospective blinded study comparing mammography in two views with Mammography + Tomosynthesis.Methods and Material:Tomosynthesis was performed in 199 patients who were assigned Breast imaging reporting and data system (BIRADS) categories 0, 3, 4, or 5 on two-dimensional (2D) mammogram. Mammograms were first categorized into one of 4 mammographic breast densities in accordance with the American College of Radiology (ACR). Three radiologists independently analyzed these images and assigned a BIRADS category first based on 2D mammogram alone, and then assigned a fresh BIRADS category after taking mammography and tomosynthesis into consideration. A composite gold-standard was used in the study (histopathology, ultrasound, follow-up mammogram, magnetic resonance imaging). Each lesion was categorized into 3 groups—superior categorization with DBT, no change in BIRADS, or inferior BIRADS category based on comparison with the gold-standard. The percentage of lesions in each group was calculated for different breast densities.Results:There were 260 lesions (ages 28–85). Overall, superior categorization was seen in 21.2% of our readings on addition of DBT to mammography. DBT was most useful in ACR Densities 3 and 4 breasts where it led to more appropriate categorization in 27 and 42% of lesions, respectively. DBT also increased diagnostic confidence in 54.5 and 63.6% of lesions in ACR Densities 3 and 4, respectively.Conclusions:In a diagnostic setting, the utility of tomosynthesis increases with increasing breast density. This helps in identifying the sub category of patients where DBT can actually change management.

Is Digital Breast Tomosynthesis Superior to Digital Mammography? A Preclinical Evaluation of Tumor Histopathological Markers Using Digital Breast Tomosynthesis

“…Moreover, DBT displayed structural distortions, microcalcifications, and foci more accu- rately than DM. In this regard, Rangarajan et al reported that DBT is useful in the detection of architectural distortions, visualizing the lesion margins clearly by eliminating tissue overlaps (12).…”

Imaging Artifacts on Synthesized Mammogram: What a Radiologist should Know!

“…By virtue of this added feature, it is able to unmask the underlying pathology that may be obscured by the superimposed fibro-glandular parenchyma or in other scenarios, confirms the absence of a mass in an apparent density caused by overlapping normal breast tissue on a conventional mammogram (MG). 1 The superimposition of structures can lead to difficulty in assessment of the margins of true masses. During the acquisition of DBT, the X-ray tube moves in an arc (15 to 60 degrees depending upon the sweep angle) over the breast simultaneously acquiring multiple low-dose projections.…”

“…By virtue of this added feature, it is able to unmask the underlying pathology that may be obscured by the superimposed fibro-glandular parenchyma or in other scenarios, confirms the absence of a mass in an apparent density caused by overlapping normal breast tissue on a conventional mammogram (MG). 1 …”

Association of the imaging characteristics of desmoplasia on digital breast tomosynthesis and the Ki-67 proliferation index in invasive breast cancer

“…The addition of tomosynthesis to 2D mammography has improved cancer detection and decreased false-positive rates ( 20 , 21 ). Furthermore, removing the effects of tissue overlap has made lesion margins more visible and improved lesion characterization ( 22 - 24 ).…”