Diagnostic accuracy of digital breast tomosynthesis in combination with 2D mammography for the characterisation of mammographic abnormalities

Vithya Visalatchi Sanmugasiva,Kartini Rahmat,Chai Hong Yeong,Faizatul Izza Rozalli,Farhana Fadzli,Nazimah Ab Mumin,Marlina Tanty Ramli Hamid

doi:10.1038/s41598-020-77456-6

Abstract

This study aims to assess the diagnostic accuracy of digital breast tomosynthesis in combination with full field digital mammography (DBT + FFDM) in the charaterisation of Breast Imaging-reporting and Data System (BI-RADS) category 3, 4 and 5 lesions. Retrospective cross-sectional study of 390 patients with BI-RADS 3, 4 and 5 mammography with available histopathology examination results were recruited from in a single center of a multi-ethnic Asian population. 2 readers independently reported the FFDM and DBT images and classified lesions detected (mass, calcifications, asymmetric density and architectural distortion) based on American College of Radiology-BI-RADS lexicon. Of the 390 patients recruited, 182 malignancies were reported. Positive predictive value (PPV) of cancer was 46.7%. The PPV in BI-RADS 4a, 4b, 4c and 5 were 6.0%, 38.3%, 68.9%, and 93.1%, respectively. Among all the cancers, 76% presented as masses, 4% as calcifications and 20% as asymmetry. An additional of 4% of cancers were detected on ultrasound. The sensitivity, specificity, PPV and NPV of mass lesions detected on DBT + FFDM were 93.8%, 85.1%, 88.8% and 91.5%, respectively. The PPV for calcification is 61.6% and asymmetry is 60.7%. 81.6% of cancer detected were invasive and 13.3% were in-situ type. Our study showed that DBT is proven to be an effective tool in the diagnosis and characterization of breast lesions and supports the current body of literature that states that integrating DBT to FFDM allows good characterization of breast lesions and accurate diagnosis of cancer.

Highlights

Breast cancer is the most common cancer in women worldwide[1]
Digital breast tomosynthesis (DBT) is a technique in breast imaging that overcomes the problems of overlapping breast tissues in full field digital mammography (FFDM) by producing multiple cross sectional images from reconstructed volume data
Inclusion criteria includes (1) patients presented for routine screening (2) patients referred for triple diagnosis due to breast-related symptoms such as breast lumps, nipple discharge or breast pain, (3) symptomatic patients, (4) women with high risk such as family history of breast cancer and on hormone replacement therapy, (5) patients assigned to Breast Imaging Reporting and Data System (BI-RADS) 3, 4 or 5 with available histopathological diagnosis via core biopsy, excisional biopsy or mastectomy

Summary

Introduction

Breast cancer is the most common cancer in women worldwide[1]. From 2009 to 2015, the 5-year relative survival rate of women with breast cancer was 99%, 85% and 27% for local disease, regional disease and breast cancer with distant metastases respectively[2]. Mammography is a proven screening modality to reduce breast cancer mortality and effective in detecting early stage breast cancer. As DBT is a relatively new technique, limited research has been done on the diagnostic accuracy in the characterisation of lesions, in multi-ethnic Asian population. Pathy et al showed that 51% of Asian women were diagnosed with breast cancer before the age of 51 based on a hospital-based cancer registry from 1990 to 2007. This is in contrast to the Caucasian women, whereby only 23% of the total breast cancer incidence were younger than 50 year-old[8]. This study aims to assess the diagnostic accuracy of DBT in combination with FFDM (DBT + FFDM) in the charaterisation of mammographic abnormality in opportunistic screening, targeted screening and diagnostic groups in a multiethnic Asian population

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Discussion

Conclusion