Abstract

BackgroundMammography is the primary imaging modality for diagnosing breast cancer in women more than 40 years of age. Digital breast tomosynthesis (DBT), when supplemented with digital mammography (DM), is useful for increasing the sensitivity and improving BIRADS characterization by removing the overlapping effect. Ultrasonography (US), when combined with the above combination, further increases the sensitivity and diagnostic confidence. Since most of the research regarding tomosynthesis has been in screening settings, we wanted to quantify its role in diagnostic mammography. The purpose of this study was to assess the performance of DM alone vs. DM combined with DBT vs. DM plus DBT and ultrasound in diagnosing malignant breast neoplasms with the gold standard being histopathology or cytology.ResultsA prospective study of 1228 breasts undergoing diagnostic or screening mammograms was undertaken at our institute. Patients underwent 2 views DM, single view DBT and US. BIRADS category was updated after each step. Final categorization was made with all three modalities combined and pathological correlation was done for those cases in which suspicious findings were detected, i.e. 256 cases. Diagnosis based on pathology was done for 256 cases out of which 193 (75.4%) were malignant and the rest 63 (24.6%) were benign. The diagnostic accuracy of DM alone was 81.1%. Sensitivity, Specificity, PPV and NPV were 87.8%, 60%, 81.3% and 61.1%, respectively. With DM + DBT the diagnostic accuracy was 84.8%. Sensitivity, Specificity, PPV and NPV were 92%, 56.5%, 89% and 65%, respectively. The diagnostic accuracy of DM + DBT + US was found to be 85.1% and Sensitivity, Specificity, PPV and NPV were 96.3%, 50.7%, 85.7% and 82%, respectively.ConclusionThe combination of DBT to DM led to higher diagnostic accuracy, sensitivity and PPV. The addition of US to DM and DBT further increased the sensitivity and diagnostic accuracy and significantly increased the NPV even in diagnostic mammograms and should be introduced in routine practice for characterizing breast neoplasms.

Highlights

  • Mammography is the primary imaging modality for diagnosing breast cancer in women more than 40 years of age

  • The most recent version of the American College of Radiology (ACR) Appropriateness Criteria for palpable breast masses states that evaluation of women 30–39 years old can begin with either mammography or ultrasound, but the previous standard recommended approach was mammography [4]

  • Using 2D Mammography 8.4% of cases were Breast imaging reporting and data system (BIRADS) 3 and 248 (20.2%) breasts were in BI-RADS Grade 4 and Grade 5

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Summary

Introduction

Mammography is the primary imaging modality for diagnosing breast cancer in women more than 40 years of age. Digital breast tomosynthesis (DBT), when supplemented with digital mammography (DM), is useful for increasing the sensitivity and improving BIRADS characterization by removing the overlapping effect. Breast cancer is the most often encountered and the most dreaded of the various pathologies that affect the breast [1]. It is the most common cancer in Indian women [2]. There are two limitations of digital mammography (DM), the first being a masking effect in dense breasts, which occurs because of overlying parenchyma, causing its low sensitivity. Since overlap of normal parenchyma can mimic a lesion, the second drawback is that it has low specificity [5]

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