Diagnostic Performance of Digital Breast Tomosynthesis for Breast Suspicious Calcifications From Various Populations: A Comparison With Full-field Digital Mammography

Juntao Li,Hengwei Zhang,Hui Jiang,Xuhui Guo,Yinli Zhang,Dan Qi,Jitian Guan,Zhenzhen Liu,Erxi Wu,Suxia Luo

doi:10.1016/j.csbj.2018.12.004

Abstract

The diagnostic performance difference between digital breast tomosynthesis (DBT) and conventional full-field digital mammography (FFDM) for breast suspicious calcifications from various populations is unclear. The objective of this study is to determine whether DBT exhibits the diagnostic advantage for breast suspicious calcifications from various populations compared with FFDM. Three hundred and five patients were enrolled (of which seven patients with bilateral lesions) and 312 breasts images were retrospectively analyzed by three radiologists independently. The postoperative pathology of breast calcifications was the gold standard. Breast cancer was diagnosed utilizing DBT and FFDM with sensitivities of 92.9% and 88.8%, specificities of 87.9% and 75.2%, positive predictive values of 77.8% and 62.1%, negative predictive values of 96.4% and 93.6%, respectively. DBT exhibited significantly higher diagnostic accuracy for benign calcifications compared with FFDM (87.9% vs 75.2%), and no advantage in the diagnosis of malignant calcifications. DBT diagnostic accuracy was notably higher than FFDM in premenopausal (88.4% vs 78.8%), postmenopausal (90.2% vs 77.2%), and dense breast cases (89.4% vs 81.9%). There was no significant difference in non-dense breast cases. In our study, DBT exhibited a superior advantage in dense breasts and benign calcifications cases compared to FFDM, while no advantage was observed in non-dense breasts or malignant calcifications cases. Thus, in the breast cancer screening for young women with dense breasts, DBT may be recommended for accurate diagnosis. Our findings may assist the clinicians in applying the optimal techniques for different patients and provide a theoretical basis for the update of breast cancer screening guideline.

Highlights

We evaluated the diagnostic accuracy of 3D digital breast tomosynthesis (DBT) relative to that of 2D mammography full-field digital mammography (FFDM) for breast suspicious calcifications, found that DBT could increase the sensitivity and specificity of the diagnosis of breast suspicious calcifications, which is quite helpful for the identification of benign calcifications, especially in young people with higher gland density
Our results suggest that the accuracy of DBT in classifying benign calcifications is significantly higher than that of FFDM, and DBT classify more benign calcifications into Breast Imaging Reporting and Data System (BI-RADS) 3 and 4A categories, probably because DBT relatively reduced the influence of overlapping tissues and radiologists are able to better assess the 3D character of a lesion in various planes [37,38]
From our data, compared with the conventional FFDM, DBT increased the sensitivity and specificity of the diagnosis of breast suspicious calcifications, which was beneficial for the identification of benign calcifications, especially in the young women with dense breasts

Summary

Introduction

Neuroscience Institute, Department of Neurosurgery, Baylor Scott & White Health, 5701 Airport Road, Temple, TX 76502, USA. A majority of calcifications are benign, while some may indicate the presence of early-stage breast cancer [1]. It is quite challenging to distinguish malignant calcifications from benign using current imaging techniques. The Breast Imaging Reporting and Data System (BI-RADS) of the American College of Radiology (ACR) clearly describes the morphology, distribution, and categories of breast calcifications, including typical benign calcifications and calcifications with suspicious morphology [2,3]. Especially clustered sand-like microcalcifications often indicate a malignant disease such as ductal carcinoma in situ (DCIS) [4].

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