Abstract
BackgroundMammography is accused of having low sensitivity and specificity in dense breast parenchyma. Also, women with dense breasts show an increased risk of developing breast cancer. Breast ultrasound has been used for several years for a better characterization of breast lesions. Contrast-enhanced mammography and tomosynthesis are relative novel imaging techniques that have been implicated in breast cancer detection and diagnosis. We aimed to compare breast tomosynthesis, contrast-enhanced mammography, and breast ultrasound as complementary techniques to mammography in dense breast parenchyma.ResultsThe study included 37 patients with 63 inconclusive mammography breast lesions. They all performed contrast-enhanced mammography, single-view tomosynthesis, and breast ultrasound. Mammography had a sensitivity of 83%, a specificity of 48%, a positive predictive value of 68%, a negative predictive value of 68%, and a diagnostic accuracy of 68%. Contrast-enhanced mammography had a sensitivity of 89%, a specificity of 89%, a positive predictive value of 91%, a negative predictive value of 86%, and a diagnostic accuracy of 89%. Tomosynthesis had a sensitivity of 86%, a specificity of 81%, a positive predictive value of 86%, a negative predictive value of 81%, and a diagnostic accuracy of 84%. Breast ultrasound had a sensitivity of 97%, a specificity of 85%, a positive predictive value of 90%, a negative predictive value of 96%, and a diagnostic accuracy of 92%.ConclusionBreast ultrasound, tomosynthesis, and contrast-enhanced mammography showed better performance compared to mammography in dense breasts. However, ultrasound being safe with no radiation hazards should be the second step modality of choice after mammography in the assessment of mammography dense breasts. Adding tomosynthesis to mammography in screening increases its sensitivity. Contrast-enhanced mammography should be reserved for cases with inconclusive sonomammographic results.
Highlights
Mammography is accused of having low sensitivity and specificity in dense breast parenchyma
Mammography Breast Imaging-Reporting and Data System (BI-RADS) category was assigned for each lesion where 19/63 (30%) lesions were considered benign, classified as BI-RADS 1, 2, and 3, while 44/63 (70%) lesions were considered malignant classified as BI-RADS 4 or 5
Tomosynthesis had a sensitivity of 86%, a specificity of 81%, a positive predictive value of 86%, a negative predictive value of 81%, and a diagnostic accuracy of 84%
Summary
Mammography is accused of having low sensitivity and specificity in dense breast parenchyma. Women with dense breasts show an increased risk of developing breast cancer. Contrast-enhanced mammography and tomosynthesis are relative novel imaging techniques that have been implicated in breast cancer detection and diagnosis. We aimed to compare breast tomosynthesis, contrast-enhanced mammography, and breast ultrasound as complementary techniques to mammography in dense breast parenchyma. Women with dense breasts encounter two major problems as increased breast density decreases the sensitivity and specificity of mammography and the dense breast itself is a risk factor for developing breast cancer [3]. Mammography is accused of having low sensitivity and specificity in dense breast parenchyma owing to a decrease in the contrast between a tumor and surrounding breast tissue, and superimposed breast tissues may obscure lesions [2]
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