Digital Breast Tomosynthesis: A New Diagnostic Method for Mass-Like Lesions in Dense Breasts

Abstract

To compare the rates and accuracy of digital breast tomosynthesis (DBT) and 2D digital mammography (DM) for detecting and diagnosing mass-like lesions in dense breasts. Mediolateral and craniocaudal images taken with DBT (affected breast) and DM (both breasts) of the dense breasts of 631 women were assessed independently using Breast Imaging Reporting and Data System (BI-RADS) scores. Images were compared for detection and diagnostic accuracy for masses; sensitivity and specificity of diagnosis; false-negative and recall rates; and clarity of display, particularly of margins and spicules. Histopathology was conducted via surgical biopsies of all patients. The detection and diagnostic accuracy rates of DBT images (84.3% and 82.3%, respectively) were significantly higher than that of DM (77.3% and 73.4%; p < 0.01, both). The sensitivity and specificity of DBT (68.1% and 95.2%) were higher than that of DM (58.8% and 86.7%), whereas the recall rate of DBT was lower (3.6% cf. 9.8%). The number of cases of benign circumscribed masses and malignant spiculated masses detected by DBT (172 and 182) was significantly higher than the number detected through DM (75 and 115; p < 0.01, both). Radiologists assigned higher BI-RADS scores for probability of malignancy to DBT images than DM, to lesions proved malignant (p = 0.025); for benign cases, the methods were comparable (p = 0.065). Compared with DM, DBT yielded significantly higher rates of detection and diagnostic accuracy for benign and malignant masses, with greater sensitivity and specificity and lower recall rates. In addition, DBT images facilitated analysis of margins, and the rate of accuracy for judgments of malignancy probability was higher, as proved on biopsy.

Comparative study between contrast-enhanced mammography, tomosynthesis, and breast ultrasound as complementary techniques to mammography in dense breast parenchyma

“…Our results were comparable with Bian et al [25] and Asbeutah et al [26] where they also found that DBT showed increased sensitivity and specificity compared to mammography in dense breasts. Phi et al [27] performed a meta-analysis on DBT in dense breasts for screening or diagnosis.…”

Diagnostic Performance of Digital Breast Tomosynthesis for Breast Suspicious Calcifications From Various Populations: A Comparison With Full-field Digital Mammography

“…Furthermore, the tube movement in DBT and the relative noise increase of each projection in wide-angle DBT may contribute to the geometric blurring [ 28 ]. Nevertheless, mild blurring of DBT images can't mask its advantage in breast screening and diagnosis [ [8] , [9] , [10] , [11] , [12] , [13] ]. According to the Mammography Quality Standards Act (MQSA) limit (a breast dose restriction of 3 mGy per acquisition) [ 34 ], slightly increasing the radiation dose of DBT may improve the blurring of DBT images.…”

“…DBT also improves preoperative breast cancer staging in dense breasts patients significantly [ 12 ]. Meanwhile, DBT shows higher detection rate and diagnostic accuracy for both benign and malignant masses, with better sensitivity and specificity and lower recall rates [ 13 ]. Our previous study also showed that DBT had a significant advantage over FFDM in the accuracy of diagnosis of breast cancer [ 14 ], especially in the diagnosis of breast mass-like lesions.…”

The role of tomosynthesis in intraoperative specimen evaluation

“…In the evaluation of breast lesions, there were some reports displaying that the areas of architectural distortion and evaluation of lesion margin were better visualized on DBT . Therefore, tomosynthesis can contribute to surgical margin assessment by demonstrating more clearly the lesion size, lesion edge characteristics and extension to surgical margin.…”