Abstract
Objectives: To compare the conspicuity of lobular breast cancers at digital breast tomosynthesis (DBT) versus synthesized 2D mammography (synt2D). Materials and methods: Seventy-six women (mean age 61.2 years, range 50–74 years) submitted to biopsy in our institution, from 2019 to 2021, with proven invasive lobular breast cancer (ILC) were enrolled in this retrospective study. The participants underwent DBT and synt2D. Five breast radiologists, with different years of experience in breast imaging, independently assigned a conspicuity score (ordinal 6-point scale) to DBT and synt2D. Lesion conspicuity was compared, for each reader, between the synt2D overall conspicuity interpretation and DBT overall conspicuity interpretation using a Wilcoxon matched pairs test. Results: A total of 50/78 (64%) cancers were detected on both synt2D and DBT by all the readers, while 28/78 (26%) cancers where not recognized by at least one reader on synt2D. For each reader, in comparison with synt2D, DBT increased significantly the conspicuity of ILC (p < 0.0001). The raw proportion of high versus low conspicuity by modality confirmed that cancers were more likely to have high conspicuity at DBT than synt2D. Conclusions: ILCs were more likely to have high conspicuity at DBT than at synt2D, increasing the chances of the detection of ILC breast cancer.
Highlights
In recent years there has been consistent evidence that synthesized mammography in place of conventional mammography in screening and symptomatic settings is at least the equal of standard 2D digital mammography in the detection of malignancy [6,7,8,9,10]
The literature confirmed that the use of digital breast tomosynthesis (DBT)
Previous studies reported the benefit of DBT compared with DM for breast cancer screening [3]; relatively little is known about differences in cancer conspicuity between the two modalities
Summary
Digital breast tomosynthesis (DBT) in combination with synthetized mammography (synt2D) has proved to be an effective imaging technique for the detection of early-stage breast cancer. This seems to be evident for invasive breast cancers, rather than in situ malignancy. As a result, enhancing the lesion margins improves the evaluation of masses and increases the detection of architectural distortions and asymmetries. This higher sensitivity of DBT for these various types of mammographic findings, especially architectural distortion, improves the visibility of invasive lobular cancers [1]. ILC remains difficult to detect, both upon physical examination, due to the absence of clinical symptoms (as a lump), and on routine mammograms, due to distinctive histopathological hallmarks
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