Abstract
Objectives
 
 To prospectively evaluate the accuracy in tumor extent and size assessment of Digital Breast Tomosynthesis (DBT) and Magnetic Resonance Imaging (MRI) in women with known breast cancer, with pathological size as the gold standard.
 
 Methods
 
 From May 2014 to April 2016, 50 patients with known breast cancer were enrolled in our prospective study. All patients underwent MRI on a 3T magnet and DBT projections. Two radiologists, with 15 and 7 years of experience in breast imaging respectively, evaluated in consensus each imaging set unaware of the final histological examination. MR and DBT sensitivity, PPV and accuracy were calculated, using histology as the gold standard. McNemar test was used to compare MR and DBT sensitivity. Correlation and regression analyses were used to evaluate MRI vs Histology, DBT vs Histology and MRI vs DBT lesions tumor size agreement to histological results. 
 
 Results
 
 On histological examination 70 lesions were detected. MRI showed 100% sensitivity, 96% PPV and 96% accuracy; DBT sensitivity was 81%, PPV 92% and accuracy 77%. McNemar test p-value was 0.0003. Lesions size Pearson correlation coefficient was 0.97 for MRI vs Histology, 0.92 for DBT vs Histology, (p-value<0.0001). MRI vs DBT regression coefficient was 0.83.
 
 Conclusions
 
 MRI confirmed to be the most accurate imaging technique in preoperative staging of breast cancer. However, DBT showed very good accuracy, sensitivity and tumor size assessment and could be a valid tool for preoperative staging when MRI is contraindicated.
Highlights
Breast cancer size assessment is one of the main guide for preoperative planning and is a crucial prognostic indicator (Luparia et al, 2013).Tumor size was commonly measured on digital mammography and ultrasound (US), but in the past decade breast cancer imaging has evolved considerably
magnetic resonance imaging (MRI) showed 100% sensitivity, 96% positive predictive value (PPV) and 96% accuracy; digital breast tomosynthesis (DBT) sensitivity was 81%, PPV 92% and accuracy 77%
The 70 malignant breast lesions detected at histologic evaluation were classified according to NHSBSP 2016 guidelines as invasive ductal carcinoma (n = 38), invasive ductal carcinoma with in situ foci (n = 12), ductal carcinoma in situ (n = 12), invasive lobular carcinoma (n = 3) (Figure 2), lobular carcinoma in situ with invasive component (n = 1), mucinous carcinoma (n = 1), mucinous carcinoma in situ (n = 1), papillary carcinoma (n = 1), papillary carcinoma in situ (n = 1)
Summary
Breast cancer size assessment is one of the main guide for preoperative planning and is a crucial prognostic indicator (Luparia et al, 2013).Tumor size was commonly measured on digital mammography and ultrasound (US), but in the past decade breast cancer imaging has evolved considerably. Several studies have confirmed the superior performance of MRI in tumor extent evaluation compared with digital mammography and US and its greater potential for preoperative staging, altering surgical decision in approximately 25% of the cases (Pediconi et al, 2012). In part, this can be ascribed to the density of the breast parenchyma and to the fact that mammography and US are limited in patients with dense parenchyma. The purpose of our study was to prospectively evaluate the accuracy in tumor extent and size assessment of DBT and MRI in women with known breast cancer, with pathological size as the gold standard
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