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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2016; 26(02): 210-215
DOI: 10.4103/0971-3026.184416
Breast

Characterization of lesions in dense breasts: Does tomosynthesis help?

Krithika Rangarajan
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
,
Smriti Hari
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
,
Sanjay Thulkar
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
,
Sanjay Sharma
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
,
Anurag Srivastava
Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
,
Rajinder Parshad
Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Context: Mammography in dense breasts is challenging due to lesion obscuration by tissue overlap. Does tomosynthesis offers a solution? Aims: To study the impact of digital breast tomosynthesis (DBT) in characterizing lesions in breasts of different mammographic densities. Settings and Design: Prospective blinded study comparing mammography in two views with Mammography + Tomosynthesis. Methods and Material: Tomosynthesis was performed in 199 patients who were assigned Breast imaging reporting and data system (BIRADS) categories 0, 3, 4, or 5 on two-dimensional (2D) mammogram. Mammograms were first categorized into one of 4 mammographic breast densities in accordance with the American College of Radiology (ACR). Three radiologists independently analyzed these images and assigned a BIRADS category first based on 2D mammogram alone, and then assigned a fresh BIRADS category after taking mammography and tomosynthesis into consideration. A composite gold-standard was used in the study (histopathology, ultrasound, follow-up mammogram, magnetic resonance imaging). Each lesion was categorized into 3 groups—superior categorization with DBT, no change in BIRADS, or inferior BIRADS category based on comparison with the gold-standard. The percentage of lesions in each group was calculated for different breast densities. Results: There were 260 lesions (ages 28–85). Overall, superior categorization was seen in 21.2% of our readings on addition of DBT to mammography. DBT was most useful in ACR Densities 3 and 4 breasts where it led to more appropriate categorization in 27 and 42% of lesions, respectively. DBT also increased diagnostic confidence in 54.5 and 63.6% of lesions in ACR Densities 3 and 4, respectively. Conclusions: In a diagnostic setting, the utility of tomosynthesis increases with increasing breast density. This helps in identifying the sub category of patients where DBT can actually change management.

Keywords

Breast cancer - dense breasts - digital breast tomosynthesis


Publication History

Article published online:
30 July 2021

© 2016. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 McCormack VA, dos Santos Silva I. Breast density and parenchymal patterns as markers of breast cancer risk: A meta-analysis. Cancer Epidemiol Biomarkers Prev 2006;15:1159-69.
  • 2 Boyd NF, Martin LJ, Yaffe MJ, Minkin S. Mammographic density and breast cancer risk: Current understanding and future prospects. Breast Cancer Res BCR 2011;13:223.
  • 3 Bertrand KA, Tamimi RM, Scott CG, Jensen MR, Pankratz V, Visscher D, et al. Mammographic density and risk of breast cancer by age and tumor characteristics. Breast Cancer Res 2013;15:R104.
  • 4 Kerlikowske K, Grady D, Barclay J, Sickles EA, Ernster V. Effect of age, breast density, and family history on the sensitivity of first screening mammography. J Am Med Assoc 1996;276:33-8.
  • 5 Carney PA, Miglioretti DL, Yankaskas BC, Kerlikowske K, Rosenberg R, Rutter CM, et al. Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Ann Intern Med 2003;138:168-75.
  • 6 Nyström L, Andersson I, Bjurstam N, Frisell J, Nordenskjöld B, Rutqvist LE. Long-term effects of mammography screening: Updated overview of the Swedish randomised trials. Lancet 2002;16;359:909-19. Erratum in Lancet 2002;360:724.
  • 7 Tabár L, Fagerberg CJ, Gad A, Baldetorp L, Holmberg LH, Gröntoft O, et al. Reduction in mortality from breast cancer after mass screening with mammography. Randomised trial from the Breast Cancer Screening Working Group of the Swedish National Board of Health and Welfare. Lancet 1985;1:829-32.
  • 8 Lewin JM, D'Orsi CJ, Hendrick RE. Digital mammography. Radiol Clin 2004;42:871-84.
  • 9 American Cancer Society. Breast Cancer Facts & [Figure 2011], [Figure 2012]. Atlanta: American Cancer Society, Inc. [cited 2013 Nov 24]. Available from: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-030975.pdf.
  • 10 Saxena S, Rekhi B, Bansal A, Bagga A, Chintamani, Murthy NS. Clinico-morphological patterns of breast cancer including family history in a New Delhi hospital, India--A cross-sectional study. World J Surg Oncol 2005;3:67.
  • 11 Raina V, Bhutani M, Bedi R, Sharma A, Deo SV, Shukla NK, et al. Clinical features and prognostic factors of early breast cancer at a major cancer center in North India. Indian J Cancer 2005;42:40-5.
  • 12 Deo SVS. Challenges in the treatment of breast cancer in developing countries. Natl Med J India 2010;23:129-31.
  • 13 Mun HS, Kim HH, Shin HJ, Cha JH, Ruppel PL, Oh HY, et al. Assessment of extent of breast cancer: Comparison between digital breast tomosynthesis and full-field digital mammography. Clin Radiol 2013;68:1254-9.
  • 14 Haas BM, Kalra V, Geisel J, Raghu M, Durand M, Philpotts LE. Comparison of Tomosynthesis Plus Digital Mammography and Digital Mammography alone for Breast Cancer Screening. Radiology 2013;269:694-700.
  • 15 Gur D, Abrams GS, Chough DM, Ganott MA, Hakim CM, Perrin RL, et al. Digital breast tomosynthesis: Observer performance study. AJR Am J Roentgenol 2009;193:586-91.
  • 16 Poplack SP, Tosteson TD, Kogel CA, Nagy HM. Digital breast tomosynthesis: Initial experience in 98 women with abnormal digital screening mammography. AJR Am J Roentgenol 2007;189:616-23.
  • 17 Lei J, Yang P, Zhang L, Wang Y, Yang K. Diagnostic accuracy of digital breast tomosynthesis versus digital mammography for benign and malignant lesions in breasts: A meta-analysis. Eur Radiol 2014;24:595-602.
  • 18 Poplack SP, Tosteson TD, Kogel CA, Nagy HM. Digital breast tomosynthesis: Initial experience in 98 women with abnormal digital screening mammography. AJR Am J Roentgenol 2007;189:616-23.
  • 19 Yang TL, Liang HL, Chou CP, Huang JS, Pan HB. The adjunctive digital breast tomosynthesis in diagnosis of breast cancer. BioMed Res Int 2013;2013:597253.
  • 20 Lourenco AP, Barry-Brooks M, Baird GL, Tuttle A, Mainiero MB. Changes in recall type and patient treatment following implementation of screening digital breast tomosynthesis. Radiology 2015;274:337-42.
  • 21 Good WF, Abrams GS, Catullo VJ, Chough DM, Ganott MA, Hakim CM, et al. Digital breast tomosynthesis: A pilot observer study. AJR Am J Roentgenol 2008;190:865-9.
  • 22 Teertstra HJ, Loo CE, van den Bosch MAAJ, van Tinteren H, Rutgers EJT, Muller SH, et al. Breast tomosynthesis in clinical practice: Initial results. Eur Radiol 2010;20:16-24.
  • 23 Lee CI, Cevik M, Alagoz O, Sprague BL, Tosteson ANA, Miglioretti DL, et al. Comparative effectiveness of combined digital mammography and tomosynthesis screening for women with dense breasts. Radiology 2015;274:772-80.
  • 24 Cai SQ, Yan JX, Chen QS, Huang ML, Cai DL. Significance and Application of Digital Breast Tomosynthesis for the BI-RADS Classification of Breast Cancer. Asian Pac J Cancer Prev 2015;16:4109-14.
  • 25 Destounis SV, Morgan R, Arieno A. Screening for dense breasts: Digital breast tomosynthesis. AJR Am J Roentgenol 2015;204:261-4.
  • 26 Yang TL, Liang HL, Chou CP, Huang JS, Pan HB. The adjunctive digital breast tomosynthesis in diagnosis of breast cancer. BioMed Res Int 2013;2013:597253.
  • 27 Margolies L, Cohen A, Sonnenblick E, Mandeli J, Schmidt PH, Szabo J, et al. Digital breast tomosynthesis changes management in patients seen at a tertiary care breast center. ISRN Radiol 2014;2014:658929.
  • 28 Hakim CM, Chough DM, Ganott MA, Sumkin JH, Zuley ML, Gur D. Digital breast tomosynthesis in the diagnostic environment: A subjective side-by-side review. AJR Am J Roentgenol 2010;195:W172-6.
  • 29 Paulis LE, Lobbes MBI, Lalji UC, Gelissen N, Bouwman RW, Wildberger JE, et al. Radiation Exposure of Digital Breast Tomosynthesis Using an Antiscatter Grid Compared With Full-Field Digital Mammography. Invest Radiol 2015;50:679-85.