Comparison of visibility of circumscribed masses on Digital Breast Tomosynthesis (DBT) and 2D mammography: are circumscribed masses better visualized and assured of being benign on DBT?

Abstract

• Circumscribed masses were better visualized on breast tomosynthesis than on 2D mammography. • Tomosynthesis visualized circumscribed masses better than 2D for all breast density categories. • Halo signs often appeared on tomosynthesis and contributed to detect circumscribed margins. • Circumscribed masses on tomosynthesis images are not assured of being benign lesions.

The added value of digital breast tomosynthesis in improving diagnostic performance of BI-RADS categorization of mammographically indeterminate breast lesions

“…Although DBT has better diagnostic performance than DM, still some breast lesions could not be determined on DBT. On DBT images, improved visualization of a partially or totally smooth boundary in some malignant masses may potentially lead to a misdiagnosis that is false benign diagnosis [29]. Thirty-six of the breast lesions in this study were misdiagnosed on DBT (20 false-positives and 16 falsenegatives).…”

Diagnostic value of halo sign in young women (aged 45 to 49 years) in a breast screening programme with synthesized 2D mammography

“…A feature to keep in mind when analysing the contour of nodular lesions is the halo sign, defined as a thin hyperlucent ring that surrounds >50% of the margin of the nodule and is detected BJR Full paper: Halo sign in young women with synthesized 2D mammography in at least one mammographic view. 7 On the other hand, the mechanism and significance of the halo sign have changed in line with the development of mammography systems. Wolfe 9 suggested that the halo sign results from the compression of fat by the circumscribing lesions.…”

“…They used an optical magnification method (magnifying glass or binocular microscope) and suggested that a halo is not always a perceptual illusion seen around benign and malignant lesions. Nakashima et al 7 suspected that halo signs in digital mammography are magnified due to the contour highlight effect of image processing. Furthermore, in tomosynthesis, this contour highlight effect overlaps due to the reconstruction of a limited number of data samples with a narrow angular range of X-ray emissions.…”

“…The analysis of data was conducted in a comprehensive manner; the patients were separated into two age groups, 45-49 years and 50-69 years (pre-and postmenopausal females) and depending on the presence or not of a halo sign. The halo sign was defined as a thin hyperlucent ring that surrounds >50% of the contour of the nodule, detected in at least one mammographic view, 7 as shown in the example of the Figure 1 and Supplementary Video 1, where positive halo sign is better visualized in 3D images of tomosynthesis followed by synthesized 2D mammogram and conventional 2D mammogram.…”

“…On the other hand, it is unclear if 2D mammograms and tomosynthesis can help differentiate between benign and malignant circumscribed nodules. 7 There is an emerging problem associated to the management of circumscribed nodules detected through this type of mammographic technique in the screened population.…”