With the Advent of Tomosynthesis in the Workup of Mammographic Abnormality, is Spot Compression Mammography Now Obsolete? An Initial Clinical Experience

Abstract

To determine if the routine use of spot compression mammography is now obsolete in the assessment of screen detected masses, asymmetries and architectural distortion since the availability of digital breast tomosynthesis. We introduced breast tomosynthesis in the workup of screen detected abnormalities in our screening center in January 2015. During an initial learning period with tomosynthesis standard spot compression views were also performed. Three consultant breast radiologists retrospectively reviewed all screening mammograms recalled for assessment over the first 6-month period. We assessed retrospectively whether there was any additional diagnostic information obtained from spot compression views not already apparent on tomography. All cases were also reviewed for any additional lesions detected by tomosynthesis, not detected on routine 2-view screening mammography. 548 women screened with standard 2-view digital screening mammography were recalled for assessment in the selected period and a total of 565 lesions were assessed. 341 lesions were assessed by both tomosynthesis and routine spot compression mammography. The spot compression view was considered more helpful than tomosynthesis in only one patient. This was because the breast was inadequately positioned for tomosynthesis and the area in question was not adequately imaged. Apart from this technical error there was no asymmetry, distortion or mass where spot compression provided more diagnostic information than tomosynthesis alone. We detected three additional cancers on tomosynthesis, not detected by routine screening mammography. From our initial experience with tomosynthesis we conclude that spot compression mammography is now obsolete in the assessment of screen detected masses, asymmetries and distortions where tomosynthesis is available.

Masses in the era of screening tomosynthesis: Is diagnostic ultrasound sufficient?

“…Several studies have shown that diagnostic DBT is Pathology is for masses that underwent core needle biopsy comparable to spot compression mammography. [1][2][3]10,11 Our study is one of the first to evaluate the impact of screening DBT on the subsequent diagnostic work-up of recalled findings. Since DBT improves differentiation of true findings from superimposition of fibroglandular tissue, mass margin visibility, and location assessment [7][8][9] and is equivalent to routine mammography in the diagnostic setting, [1][2][3]10,11 it is not surprising that most DBT screen-detected masses in the US first group in our study did not require a diagnostic mammogram.…”

Diagnostic performance with and without artificial intelligence assistance in real-world screening mammography

“…Mammography is the primary screening modality for breast cancer that improves survival rates [1] , [2] . However, fibroglandular breast tissue can obscure suspicious lesions which limits the sensitivity of mammography, and sometimes this tissue can mimic true lesions, resulting in false-positive recalls [3] , [4] . In the late 1990s, traditional computer-aided detection was introduced to improve the human detection of breast cancer, but subsequent large-scale validation studies concluded that it failed to improve human performance due to excessive recalls and an increase in unnecessary additional examinations [5] , [6] , [7] .…”

Artificial intelligence assistance for women who had spot compression view: reducing recall rates for digital mammography

“…Mammography is the principal screening modality proven to reduce breast cancer mortality (1,2). Since standard mammography, including the mediolateral oblique and craniocaudal views, results in two-dimensional (2D) images, the glandular tissue of the breast may obscure small breast cancers and cause unnecessary recall and false-positive results, especially in dense breasts (3,4). The American College of Radiology (ACR) recommends a target recall rate of <10% for screening mammography (5,6) to reduce the number of unnecessary recalls without compromising the cancer detection rate.…”

“…The first workup for focal asymmetry, asymmetry, mass, or architectural distortion seen on screening mammography is the spot compression view; focal pressure is applied to the targeted area of the breast in order to displace superimposed glandular tissue and to determine whether the abnormality is true (4). An advanced imaging technique of digital breast tomosynthesis provides a series of sequential slice images for a three-dimensional (3D) view of the breasts and also spreads the overlapping tissue, which might mask abnormal lesions (9)(10)(11)(12)(13).…”