The diagnostic value of digital breast tomosynthesis plus synthesized two-dimensional images in breast disease

Abstract

Objective To investigate the diagnostic value of digital breast tomosynthesis (DBT) plus synthesized two-dimensional(2D) images (C-view) in benign and malignant breast disease. Methods The prospective study enrolled 93 women with a clinically suspicious breast lesion confirmed by pathology. All patients underwent full-field digital mammography (FFDM) and DBT examinations before surgery or biopsy. Synthesized 2D images (C-view) were reconstructed in DBT. The images in FFDM alone, DBT plus C-view, and DBT plus FFDM were observed, the average glandular dose was recorded and the visibility grade of the disease was evaluated. Pathological analysis was performed on biopsy and surgical specimen to acquire histopathologic type. The average glandular dose among three examinations was compared by analysis of variance, and the visibility grade was compared by Wilcoxon matched-pairs signed-ranks test. The manifestation of breast disease in different examinations was evaluated according to breast imaging reporting and data system (BI-RADS). Taking pathologic results as the gold standard, receiving operating characteristic (ROC) was performed to analyze the diagnostic efficiency of three examinations. Result All lesions in 93 cases were solitary, in which 27 were benign and 66 were malignant. Sixteen cases were pathologically confirmed by biopsy and 77 cases by surgery. For the average glandular dose, there was significant difference among three examinations (P<0.01); it decreased by 50.0%(1.95/3.90) in FFDM alone and DBT plus C-view than DBT plus FFDM. All cases showed the same visibility between DBT plus C-view and DBT plus FFDM, in which 54 cases (58.1%,54/93) showed increased visibility than FFDM (P<0.01). The sensitivity and specificity were both highest in DBT plus C-view (90.9% and 85.2% respectively) to differentiate benign and malignant breast disease. The area of ROC curve in FFDM alone, DBT plus C-view, and DBT plus FFDM were 0.756, 0.880 and 0.862 respectively. Conclusion The combination of synthesized 2D images and DBT can improve both detection of breast lesion and diagnostic efficiency compared with FFDM, without an increase in radiation dose to the breast. Key words: Breast neoplasms; Mammography; Digital breast tomosynthesis