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

Abstract

Background Breast tomosynthesis is more sensitive than mammography and can detect lesions that are not always visible with conventional methods such as digital mammography (MG) and ultrasonography (US). No standardized approach is available for the management of lesions that are detectable with tomosynthesis but are not visible on MG or US. Purpose To review suspicious breast lesions detected with tomosynthesis but not visible on two-dimensional (2D) MG or US and to determine the management options for these lesions. Material and Methods Ethical committee approval was obtained. The radiological records, biopsy or surgery results, and follow-up findings of 107 patients who had a tomosynthesis-positive but MG- or US-negative breast lesion between 2011 and 2016 were retrospectively evaluated. Results Of 107 lesions visible only with tomosynthesis, 74% were architectural distortions and 26% were asymmetrical opacities. All patients underwent magnetic resonance imaging (MRI) for further evaluation. Among the 48 (45%) MRI-negative lesions, none had a suspicious alteration during the follow-up period. Among the MRI-positive lesions, 28% of the 50 architectural distortions and 11% of the nine asymmetrical opacities were malignant. Conclusion Given the inherent high false-positive rate of breast tomosynthesis, breast MRI prior to biopsy may reduce the number of unnecessary biopsies for suspicious breast lesions that are tomosynthesis-positive only.

Malignant Outcomes of Architectural Distortion on Tomosynthesis: A Systematic Review and Meta-Analysis

“…If and when to biopsy AD seen on DBT has been questioned. Recent studies [15][16][17][18][19][20][21][22][23][24][25][26][27] examining AD on DBT included small numbers of patients, ranging from 14-274 patients, and described varying rates of malignancy. Hence, a thorough assessment is needed of rates of malignancy in AD detected on DBT.…”

“…diagnostic mammography [15,16,19,21,[23][24][25][26], 3 on screening only [18,22,27], and 1 on diagnostic only [17];1 study did not clearly define the initial mode of presentation [20] (Table 1).…”

“…Three studies excluded AD with any associated findings (masses, asymmetries, and calcifications) [15,17,27]. One study included lesions with all associated findings [18], 3 studies did not specify if associated findings were included [20,25,26], and the remaining studies included AD with some associated findings and excluded AD with other associated findings [16,19,[21][22][23][24] (Table 1).…”

“…Four studies did not specify if DBT-only-detected or DM with DBT-detected lesions were included [16,18,21,23] (Table 2). From the remaining 9 studies, 6 studies [19,20,22,[24][25][26]] assessed only DBT-detected lesions, whereas the other 3 evaluated both lesions seen on DBT alone and on DM with DBT [15,17,27]. All but two studies [19,22] differentiated invasive from in situ cancers on histopathology ( Table 2).…”

“…All studies were deemed appropriate to answer the research question by both reviewers. Per the QUADAS-2 tool, there was a high risk of bias in five studies related to patient inclusion [15,20,22,24,26] given that patients with ultrasound correlates of AD were excluded, potentially affecting the PPV for malignancy. Additionally, there was a high risk of bias for patient inclusion in two studies [18,24] given that AD with masses were not excluded.…”