Characterization of lesions in dense breasts: Does tomosynthesis help?

Krithika Rangarajan; Smriti Hari; Sanjay Thulkar; Sanjay Sharma; Anurag Srivastava; Rajinder Parshad

doi:10.4103/0971-3026.184416

Indian Journal of Radiology and Imaging, Table of Contents

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?

Authors

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

Abstract

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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

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References

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