Abstract
ObjectivesTo compare breast density measured on digital breast tomosynthesis (DBT) (BI-RADS-based breast composition and fully-automatic estimation) and magnetic resonance imaging (MRI) (BI-RADS amount of fibroglandular tissue), and to evaluate the diagnostic performance in terms of sensitivity and specificity of DBT and MRI in a predominantly dense breast population.MethodsBetween 2015 and 2016, 152 women with 103 breast malignancies, who underwent 3-T breast MRI and DBT within 2 months’ time, were enrolled in this study. Breast composition/fibroglandular tissue and findings on DBT (two readers) and MRI were reported using BI-RADS 5th edition. Digital mammography images were analysed for breast percent density (PD) using the Libra software tool.ResultsA majority of women had dense breasts as categorised by breast composition c (heterogeneously dense) (68%) and d (extremely dense) (15%). The mean PD was 44% (range, 18-89%) and the correlation between breast composition and PD was r = 0.6. The diagnostic performance of MRI was significantly higher compared to DBT for one reader as described by the area under the receiver operating characteristic (ROC) curve (p = 0.004) and of borderline significance for the other reader (p = 0.052).ConclusionsMRI had higher diagnostic performance than DBT in a dense breast population in the tertiary setting.Key Points• MRI had higher diagnostic performance than DBT in a dense breast population• Diagnostic performance of DBT was comparable to MRI in women with fatty breasts• MRI was superior to DBT in preoperative breast cancer size assessment
Highlights
Digital breast tomosynthesis (DBT) has gained increasing interest in the clinic for routine everyday use, with several early clinical studies showing superior accuracy compared to that of mammography [1,2,3]
Skaane et al [7] stated: BNotably, the additional cancers detected with mammography plus tomosynthesis were distributed across all breast densities, including fatty breasts^
Breast cancer risk increases with increasing breast density [10, 11]
Summary
Digital breast tomosynthesis (DBT) has gained increasing interest in the clinic for routine everyday use, with several early clinical studies showing superior accuracy compared to that of mammography [1,2,3]. Lång et al [9] reported that the additional cancers were detected both in women with dense and fatty breasts, drawing the conclusion that in mammography even a moderate amount of breast tissue can conceal a small lesion. In order to more objectively assess breast density and to reduce interobserver and intraobserver variability, quantitative measurements have been developed [18, 19] Both qualitative and quantitative methods of measuring breast density have shown an association between high breast density and breast cancer risk [11, 20]
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