Overview of digital breast tomosynthesis: Clinical cases, benefits and disadvantages

Abstract

In France, the national breast cancer-screening program is based on mammography combined with clinical breast examination, and sometimes breast ultrasound for patients with high breast density. Digital breast tomosynthesis is a currently assessed 3D imaging technique in which angular projections of the stationary compressed breast are acquired automatically. When combined with mammography, clinicians can review both conventional (2D) as well as three-dimensional (3D) data. The purpose of this article is to review recent reports on this new breast imaging technique and complements this information with our personal experience. The main advantages of tomosynthesis are that it facilitates the detection and characterization of breast lesions, as well as the diagnosis of occult lesions in dense breasts. However, to do this, patients are exposed to higher levels of radiation than with 2D mammography. In France, the indications for tomosynthesis and its use in breast cancer-screening (individual and organized) are yet to be defined, as is its role in the diagnosis and staging of breast cancer (multiple lesions). Further studies assessing in particular the combined reconstruction of the 2D view using 3D tomosynthesis data acquired during a single breast compression event, and therefore reducing patient exposure to radiation, are expected to provide valuable insight.

Digital breast tomosynthesis (DBT) value in breast mass detection

“…Numerous previous reports have confirmed that using DBT causes the increase of the detection efficiency of malignant lesions in the mammary glands, and the decrease in the number of false negative results and the reduction of repeated calls of patients for supplementary tests with false positive results [6][7][8][9]. Digital breast tomosynthesis is more sensitive than fullfield digital mammography in detecting focal lesions in the breast.…”

“…Main advantages of DBT technique in comparison with FFDM are high-contrast visibility, greater visibility of the margins of pathological masses and more precise determination of lesion size [6][7][8][9][10].…”

“…According to ALARA (as low as reasonably achievable) scale, diagnostic examination should be performed using the lowest possible radiation dosage [8]. X-ray dosage in each image projection in DBT technique is lower than X-ray dosage resulting from FFDM examination.…”

Review and management of breast lesions detected with breast tomosynthesis but not visible on mammography and ultrasonography

“…BT remains under investigation as a complementary screening tool to MG. More masses and architectural distortion lesions are detected with tomosynthesis (11–13,15–17). Our aim was to evaluate non-calcified lesions detected only on BT.…”

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

“…Using the combo-mode, within the same examination, 2D digital mammography and tomosynthesis are performed, with the advantage for the radiologist to compare the information provided by the two modalities and to increase the accuracy of the interpretation, but also with the disadvantage for the patient due to the risk of the increased irradiation dose. The replacement of 2D mammography with the synthesized 2D images from tomosynthesis might reduce with almost 50% the irradiation dose, and this is the subject of many studies conducted in the present [ 1 , 11 , 12 ].…”