Local Tumor Staging of Breast Cancer: Digital Mammography versus Digital Mammography Plus Tomosynthesis

Abstract

Background: Combined digital mammography (DM) and digital breast tomosynthesis (DBT) (hereafter, DM plus DBT) has increased cancer detection rates when compared with those achieved with DM-only screening. However, there is limited literature on DBT as an adjunct to mammography in the staging of known breast cancers. Purpose: To compare the diagnostic accuracy of DM alone with that of DM plus DBT in the identification of additional ipsilateral and contralateral lesions in women with newly diagnosed breast cancer. Materials and Methods: This prospective study (https://clinicaltrials.gov, NCT01881880) included 166 women with breast cancer (mean age, 59.5 years 6 11; age range, 40-87 years) and used the aforementioned techniques, with breast MRI and pathologic verification of all suspected lesions as the reference standards. Four radiologists independently reviewed the DM and DM plus DBT images using the American College of Radiology Breast Imaging Reporting and Data Systems criteria for diagnosis of index lesions and presence of additional disease. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) obtained for DM and DM plus DBT were compared by using the McNemar test. Results: Twenty-four women (14%) exhibited multifocal lesions; 20 (12%), multicentric lesions; 39 (23%), additional ipsilateral lesions; and 18 (11%), bilateral lesions. The sensitivities were higher for DM plus DBT than for DM in the diagnosis of multicentric (51% [41 of 80] vs 37% [30 of 80], P = .002) and additional ipsilateral (52% [81 of 156] vs 44% [69 of 156], P = .007) lesions. The AUC was larger for DM plus DBT than for DM (0.74 vs 0.67, P = .02) in the diagnosis of bilateral breast cancer. No significant differences in specificity were noted. The added diagnostic value of DBT was limited to the group of women with nondense breasts: For diagnosis of ipsilateral lesions, AUC of DM plus DBT versus DM was 0.74 versus 0.70 (P = .04). For diagnosis of contralateral lesions, AUC of DM plus DBT verus DM was 0.76 versus 0.68 (P = .02). Conclusion: The combination of digital mammography with digital breast tomosynthesis improves diagnostic accuracy for additional ipsilateral and contralateral breast cancer in women with nondense breasts.

Multicentric and multifocal breast cancer diagnostics (review and portfolio)

“…After labeling the carcinoma, mammographic control is recommended. Ultrasound (US) is effective in recognizing X-ray negative lobular breast carcinoma, but with multicentric and bilateral tumor spread characteristic for lobular breast carcinoma, the effectiveness of US is reduced [17,22,25].…”

Is Digital Breast Tomosynthesis the Better Mammogram for Local Breast Cancer Staging?

“…In this issue of Radiology, Fontaine and colleagues report outcomes from their prospective multicenter trial on the role of tomosynthesis in breast cancer diagnosis and staging (8). The authors identified 166 women with breast cancer who underwent digital mammography, DBT, and breast MRI to evaluate for additional disease.…”

“…In the study by Fontaine et al (8), the improved diagnostic performance of tomosynthesis and digital mammography for additional breast cancers was limited to women with nondense breasts. This result may seem counterintuitive, given that tomosynthesis is known to improve visualization of breast cancer by reducing the effects of tissue superimposition, particularly in women with dense breasts.…”

“…In addition, studies show that women undergoing breast MRI have a higher likelihood of undergoing mastectomy. Fontaine and colleagues found that 36% of the women in their study underwent mastectomy (8). A factor fueling the debate over imaging for extent of disease is whether the additional disease detected with various imaging modalities leads to detection of aggressive disease and decreased mortality from breast cancer.…”

“…A limitation of the study by Fontaine and colleagues is the lack of detailed information about tumor characteristics and molecular subtypes of both the primary cancer and the additional disease detected with DBT (8). This information, as well as interval cancer rates, will be forthcoming in their future analysis.…”