Digital Mammography Tomosynthesis Research Articles

Assessment of scatter radiation dose received by comforters and carers during digital breast tomosynthesis mammography.

Mammographic imaging can cause considerable stress and anxiety for some patients and may require someone to remain in the room during the procedure to provide both physical and emotional support. As such, these comforters and carers (C&C) are exposed to ionising radiation. Limited evidence is available stating the radiation dose received during a digital breast tomosynthesis (DBT) examination. This research aims to determine the optimal standing position for a C&C in the mammography room during a DBT mammogram that results in the lowest radiation dose, whilst providing high-quality imaging, care and comfort to the patient. A scatter detector was used to measure the dose at different standing positions of the carer relative to the patient during an examination. A polymethyl methacrylate (PMMA) phantom was also used to model the patient's breast and torso for further scatter dose measurements. The median air kerma for craniocaudal views posterior to the patient is 0.75 μGy compared with 10.1 μGy to either side. The median air kerma for mediolateral oblique views for posterolateral position is 0.41 μGy compared with 2.6 μGy anterolateral. No significant effect from breast density is noted from the dataset. The optimal position for the C&C to stand is directly behind the patient in the craniocaudal position, and as far as possible posterolateral to the breast being imaged in the mediolateral oblique position. These two positions will result in the least radiation dose to the C&C.

Do automated breast ultrasound and tomosynthesis have an effective role in dense breast evaluation?

BackgroundMammography plays a great role in reducing breast cancer mortality as it is the standard method of breast imaging and screening. But the accuracy of mammography performance reduces in cancer detection in women with dense breast due to the summation of images and overlapping of breast tissue. ABUS and tomosynthesis both recently help to detect breast cancer in dense breasted women. This prospective study was done in the female imaging unit and approved by its research and ethical committee; all the patients did an informed consent during the period from October 2018 to March 2019. The study was conducted on 38 patients with 38 lesions subjected to digital mammography, tomosynthesis and automated breast ultrasound (ABUS), who all had dense breast in mammography.ResultsAutomated breast ultrasound (ABUS) showed 100% in all sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) as well as accuracy, while the digital mammography tomosynthesis showed 100% in specificity, 87.5% in sensitivity, 100% in PPV, 82.4% in NPV and 92.1% accuracy.ConclusionAutomated breast ultrasound (ABUS) together with tomosynthesis makes a revolution in breast screening and detecting cancer in women with dense breasts.

Evaluation of Breast Galactography Using Digital Breast Tomosynthesis: A Clinical Exploratory Study.

Objectives: To compare the application value of digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) in breast galactography. Materials and Methods: A total of 128 patients with pathological nipple discharge (PND) were selected to undergo galactography. DBT and FFDM were performed for each patient after injecting the contrast agent; the radiation dose of DBT and FFDM was calculated, and the image quality was evaluated in consensus by two senior breast radiologists. Histopathologic data were found in 49 of the 128 patients. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for both FFDM- and DBT-galactography were calculated using histopathologic results as a reference standard. Data were presented as percentages along with their 95% confidence intervals (CI). Results: The average age of the 128 patients was 46.53 years. The average glandular dose (AGD) of DBT-galactography was slightly higher than that of FFDM-galactography (p < 0.001). DBT-galactography was 30.7% higher than FFDM-galactography in CC view, while DBT-galactography increased by 21.7% compared with FFDM-galactography in ML view. Regarding catheter anatomic distortion, structure detail, and overall image quality groups, DBT scores were higher than FFDM scores, and the differences were significant for all measures (p < 0.05). In 49 patients with pathological nipple discharge, we found that the DBT-galactography had higher sensitivity, specificity, PPV, and NPV (93.3%, 75%, 97.7%, and 50%, respectively) than FFDM-galactography (91.1%, 50%, 95.3%, and 33.3%, respectively). Conclusions: Compared to FFDM-galactography, within the acceptable radiation dose range, DBT-galactography increases the sensitivity and specificity of lesion detection by improving the image quality, providing more confidence for the diagnosis of clinical ductal lesions.

Imaging Spectrum of Lobular Carcinoma In Situ and Correlation with Pathology Findings.

Background Lobular carcinoma in situ (LCIS) is a noninvasive neoplasm that is known to have an increased relative risk for developing subsequent invasive breast carcinoma. Pure LCIS is usually an incidental finding on histopathological examination (HPE) of tissue samples. However, in the recent years, there has been an increasing trend seen in the diagnosis of LCIS. Purpose This article aims to bring out the spectrum of appearances on breast imaging in confirmed cases of pure LCIS on HPE and immunohistochemical. Materials and Methods Cases that were confirmed as pure LCIS on HPE from core or excision biopsy were retrospectively analyzed for abnormalities on breast imaging. Digital breast tomosynthesis mammography was performed with high-resolution ultrasound with elastography for all cases. Magnetic resonance imaging (MRI) was performed in cases wherever indicated, with dynamic postcontrast imaging after injecting intravenous gadolinium. Conclusion LCIS is recognized as an intermediate risk factor for the development of breast cancer. Pure LCIS has varied histology and imaging patterns on mammography, high-resolution ultrasound, and MRI. It is important to recognize the imaging appearances of these lesions to enable the radiologist to detect LCIS early for proper management.

Comparison of two-dimensional synthesized mammograms versus original digital mammograms: a quantitative assessment.

This study objectively evaluates the similarity between standard full-field digital mammograms and two-dimensional synthesized digital mammograms (2DSM) in a cohort of women undergoing mammography. Under an institutional review board-approved data collection protocol, we retrospectively analyzed 407 women with digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) examinations performed from September 1, 2014, through February 29, 2016. Both FFDM and 2DSM images were used for the analysis, and 3216 available craniocaudal (CC) and mediolateral oblique (MLO) view mammograms altogether were included in the dataset. We analyzed the mammograms using a fully automated algorithm that computes 152 structural similarity, texture, and mammographic density-based features. We trained and developed two different global mammographic image feature analysis-based breast cancer detection schemes for 2DSM and FFDM images, respectively. The highest structural similarity features were obtained on the coarse Weber Local Descriptor differential excitation texture feature component computed on the CC view images (0.8770) and MLO view images (0.8889). Although the coarse structures are similar, the global mammographic image feature-based cancer detection scheme trained on 2DSM images outperformed the corresponding scheme trained on FFDM images, with area under a receiver operating characteristic curve (AUC) = 0.878 ± 0.034 and 0.756 ± 0.052, respectively. Consequently, further investigation is required to examine whether DBT can replace FFDM as a standalone technique, especially for the development of automated objective-based methods.

Comparison between Visualization of Microcalcifications by Digital Breast Tomosynthesis and Full-Field Digital Mammography

Objective: To date, few studies have compared the diagnostic performance and visibility of microcalcifications obtained using digital breast tomosynthesis (DBT) with those obtained from full-field digital mammography (FFDM). The visualization and characterization of microcalcifications with DBT remain controversial. The purpose of this study was to compare the visibility of microcalcifications and determine whether DBT exhibits a diagnostic advantage for visualizing microcalcifications over FFDM. Methods: We retrospectively reviewed 120 cases including DBT and FFDM imaging (60 histologically verified as breast cancers and 60 as benign microcalcifications or normal). DBT images with a wide scan-angle of 50° and FFDM images were obtained using a flat-panel system (MAMMOMAT Inspiration, Siemens). Images were independently reviewed by four board-certified radiologists and evaluated for the presence of microcalcifications, probability of malignancy (BI-RADS classification), and visibility. Results: In predicting the malignancy of detected microcalcifications, no significant difference was found between readers’ areas under the receiver operating characteristic curve for DBT and FFDM (p = 0.068). The visibility scores of detected microcalcifications were 3.74 ± 1.06 for DBT and 3.46 ± 0.93 for FFDM, respectively. The visibility of microcalcifications when using DBT was found to be significantly superior to that of FFDM (p < 0.05). Conclusion: Our results suggest that the image quality of DBT with a wide scan-angle is comparable or superior to that obtained with FFDM in terms of both visibility and assessment of microcalcifications.

Digital Breast Tomosynthesis Mammography System Registration Application Data Technical Review Concerns

In this paper, the focus of technical review of the registration application data of digital Breast Tomosynthesis Mammography System was sorted out, so as to provide reference for researchers and manufacturers in China when applying for registration and preparation of such products.

Abstract PD7-05: Comparative costs of breast cancer screening with digital breast tomosynthesis versus digital mammography: A health system perspective

Abstract Background Digital breast tomosynthesis (DBT) is being rapidly implemented in breast cancer screening and demonstrates improved specificity and sensitivity compared to screening with digital mammography (DM) alone. Prior work based on payer perspectives has demonstrated that DBT can be cost-effective. However, DBT is costlier than DM, and there are little data from a health system perspective about the comparative test performance and costs of DBT versus DM. Methods We evaluated breast cancer screening episodes in a single health system between January 1, 2012 and December 31, 2013. A screening episode was defined as a single screening mammogram and all downstream breast diagnosis related costs for the following 1 year. Episodes were excluded if the patient had a prior diagnosis of breast cancer or reached 90 years of age before the end of the follow-up period. Test performance with respect to four outcomes – true positive (TP), true negative (TN), false positive (FP), and false negative (FN) rates – was determined by comparing the BI-RADS score assigned at screening with data about subsequent cancer diagnosis from institutional and state cancer registries. Cost data were developed using CPT codes collected from organizational billing systems and converted to the Medicare Physician Fee Payment Schedule for our region with an imputed additional charge of $60.16 for DBT. Based on this approach, a DM screening exam cost $155.66 and a DBT screening exam cost $215.82. We evaluated overall costs across a screening episode, as well as by four windows: screening, follow-up, diagnosis, and cancer treatment. Data were described using percentages, and Chi-squared and Fisher's exact tests were used to evaluate differences in test performance outcomes and costs based on screening technology. Results There were a total of 46,483 cost episodes during the study period, of which 24,502 (52.7%) were screened by DM and 21,981 (47.3%) were screened by DBT. Overall, there were 224 TP (0.5%), 29 FN (0.1%), 4,530 FP (9.8%), and 41,700 TN (89.7%) episodes. Compared to DM episodes, DBT episodes had lower FP (8.6% vs. 10.8%, p&amp;lt;0.001) and higher TN (90.9% vs. 88.7%, p&amp;lt;0.001) rates. There were no statistically significant differences between DBT and DM episodes with respect to TP and FN rates. Overall, average episode costs were higher for DBT compared to DM ($378.02 vs. $286.62, p&amp;lt;0.001). This $91.40 difference was driven by higher average screening costs ($215.94 vs. $155.76, p&amp;lt;0.001), which approximated the additional charge for DBT, as well as follow-up costs ($23.67 vs. $12.11, p&amp;lt;0.001). There was no significant difference in costs between DBT and DM episodes within the diagnosis or cancer treatment windows. Compared to DM episodes, DBT episodes had equivalent average episode costs per woman screened for FP ($67.75 vs. $65.71, p=0.49), FN ($4.63 vs. $5.60, p=0.69) and TP ($85.80 vs. $65.15, p=0.07) outcomes, but higher costs for TN ($219.84 vs. $150.16, p&amp;lt;0.001) outcomes. Conclusion At a single health system, screening with DBT decreased FP rates and increased TN rates compared to screening with DM. DBT costs more overall, but not on a per-woman-screened basis for FP, FN, and TP outcomes. Citation Format: Liao GJ, Glick HA, Synnestvedt MB, Schnall MD, Conant EF. Comparative costs of breast cancer screening with digital breast tomosynthesis versus digital mammography: A health system perspective [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD7-05.

Pathologic Upgrade Rates of High-Risk Breast Lesions on Digital Two-Dimensional vs Tomosynthesis Mammography

Our aim was to compare the pathologic upgrade rates of high-risk breast lesions (HRLs) on digital two-dimensional mammography (DM) vs digital breast tomosynthesis (DBT). The study cohort was composed of patients with HRLs diagnosed by image-guided core needle biopsy from December 2007 to February 2011 (DM group, before DBT integration) and from January 2013 to March 2016 (DBT group, after complete DBT integration). Medical records were reviewed for surgical outcomes and follow-up imaging. Eight hundred and ninety-three patients with 900 biopsy-proven HRLs underwent surgical excision (97.0% [873 of 900]) or had at least 2 years of imaging follow-up (3.0% [27 of 900]). The most common HRL was atypical ductal hyperplasia in the DM and DBT groups (37.4% [337 of 900]). The overall upgrade rate of HRLs to malignancy was 11.3% (102 of 900). There were no statistically significant differences in overall upgrades rates of HRLs on DM vs DBT (11.4% [54 of 475] vs 11.3% [48 of 425]; p= 0.97) or in upgrade rates of HRL subtypes. However, HRLs that upgraded on DBT were more likely to be invasive rather than in situ carcinoma compared with HRLs that upgraded on DM (39.6% [19 of 48] vs 20.4% [11 of 54]; p= 0.03). Overall, the most common HRL to upgrade was atypical ductal hyperplasia (18.4% [62 of 337]). The least common HRLs to upgrade in the DBT group were biphasic neoplasms (0% [0 of 22]), flat epithelial atypia (1.6% [1 of 62]), and papillomas without atypia (4.5% [2of44]). There is no difference in the upgrade rates of HRLs on DM vs DBT, but the proportion of HRL upgrades that are invasive rather than in situ carcinoma is higher with DBT.

A Practical Truncation Correction Method for Digital Breast Tomosynthesis

Digital breast tomosynthesis (DBT) mammography is a promising imaging technique for detecting early-stage breast cancers. However, DBT imaging usually contains truncation artifacts around the chest wall area, where many recurring breast tumors or masses are located. Extrapolation or interpolation and weighting techniques are used to suppress artifacts in existing methods, but these are inappropriate for DBT due to its high spatial resolution requirement. To solve this problem, we propose a practical truncation correction method, which can realize simultaneous truncation artifact reduction and image reconstruction (STARIR) for DBT. In contrast to extrapolation or interpolation estimations and weighting strategy, this integrated method renews each truncated voxel by considering the information of all measured projections rather than that of one projection at each reconstruction iteration. Qualitative and quantitative studies were performed on simulated and realistic DBT data to validate the proposed method. Results showed that STARIR reduces truncation artifacts and preserves tissue details in reconstructed images more effectively than do the current methods. The proposed method can be used for simultaneous and accurate truncation artifact reduction and image reconstruction in DBT.

Diagnostic performance of digital breast tomosynthesis and full-field digital mammography with new reconstruction and new processing for dose reduction.

The main barrier to adoption of digital breast tomosynthesis (DBT) plus full-field digital mammography (FFDM) is radiation exposure dose. The purpose of this study was to evaluate the diagnostic performance of DBT plus FFDM, both with newly developed technology (nd), at a dose comparable to that of the conventional FFDM alone. Nine hundred and thirteen participants were recruited from May 2014 to January 2016 consecutively. For each subject, the exposure setting for DBT(nd)+FFDM(nd) was also used for the conventional FFDM alone. Retrospective reader studies were performed: DBT(nd)+FFDM(nd) (142 cases, including 42 cancer cases) and conventional FFDM (258 cases, including 87 cancer cases). Eight radiologists provided Japanese categorizations and probability of malignancy independently. Diagnostic performance was assessed by comparing sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). Two-sided P values were calculated. DBT(nd)+FFDM(nd) showed sensitivity and AUC significantly increased over the conventional FFDM (85.4 vs. 80.3%, P=0.015 and 90.9 vs. 88.3%, P=0.049) and specificity did not significantly increase (89.6 vs. 88.4%, P=0.52). The mean glandular dose (MGD) difference of DBT(nd)+FFDM(nd) and conventional FFDM was not significant (difference -0.11mGy, P=0.08). In this study population, DBT plus FFDM, both with newly developed technology, provided diagnostic performance improved over the conventional FFDM alone, even at comparable MGD.

Strategies for Decreasing Screening Mammography Recall Rates While Maintaining Performance Metrics

This study aimed to determine the impact of interventions designed to reduce screening mammography recall rates on screening performance metrics. We assessed baseline performance for full-field digital mammography (FFDM) and digital breast tomosynthesis mammography (DBT) for a 3-year period before intervention. The first intervention sought to increase awareness of recalls from screening mammography. Breast imagers discussed their perceptions regarding screening recalls and were required to review their own recalled cases, including outcomes of diagnostic evaluation and biopsy. The second intervention implemented consensus double reading of all recalls, requiring two radiologists to agree if recall was necessary. Recall rates, cancer detection rates, and positive predictive value 1 (PPV1) were compared before and after each intervention. The baseline recall rate, cancer detection rate, and PPV1 were 11.1%, 3.8/1000, and 3.4%, respectively, for FFDM, and 7.6%, 4.8/1000, and 6.0%, respectively, for DBT. Recall rates decreased significantly to 9.2% for FFDM and to 6.6% for DBT after the first intervention promoting awareness, as well as to 9.9% for FFDM after the second intervention implementing group consensus. PPV1 increased significantly to 5.7% for FFDM and to 9.0% for DBT after the second intervention. Cancer detection rate did not significantly change with the implementation of these interventions. An average of 2.3 minutes was spent consulting for each recall. Reduction in recall rates is desirable, provided performance metrics remain favorable. Our interventions improved performance and could be implemented in other breast imaging settings.

Abstract C74: Screening outcomes of digital Breast tomosynthesis versus digital mammography in an underserved population with multiple disparities

Abstract Purpose: The purpose of this report is to compare screening outcomes in an underserved population in North Louisiana with two different imaging techniques: digital breast tomosynthesis and standard digital mammography. Digital breast tomosynthesis (DBT) is a relatively new technology that images the breast in 3-D which is thought to overcome limitations of standard (2-D) digital mammography (DM). The outcome measures for this report are: 1) recalls for further mammography and evaluation and 2) breast cancers confirmed by biopsy. Background: The LSU Feist-Weiller Cancer Center has operated a free cancer screening clinic for uninsured and under-insured women since 1999. We started with one clinic in a fixed location in the LSU hospital in Shreveport, Louisiana. Since 2009 cancer screens are also routinely performed by 2 mobile units in 28 rural, underserved locations in 24 parishes in North Louisiana. Permanent mammography facilities are not available in 40% of the parishes we serve. For this population, in the remote rural areas, or the working poor in the non-rural areas, recalls are a significant extra burden on the patients. Methods: In 2009 we started mobile mammography screening with a Hologic Selenia Digital mammogram machine onboard. In 2014 we obtained another vehicle which was especially designed for the Hologic Dimension Tomographic mammography machine. DBT in a mobile setting is rare, with very few implementations in the U.S. In Louisiana, we have the only mobile DBT unit, statewide. This presents an unique opportunity to evaluate this new technology, in a mobile screening program in a high-risk population with multiple disparities. The subjects used in this presentation are those seen on one of the two mobile screening vehicles between April 1, 2009 and December 31, 2015. All patients screened qualified as either uninsured or under-insured and their mammograms were paid for by one of a multiple number of grants. All cancer screens were performed according to American Cancer Society guidelines by technologists certified in mammography. All mammographic images were digital. Images were read by one of two board certified radiologists, specialists in mammography and both trained to read DBT images. Of special interest to this presentation is the number of patients who are called recalled for additional views or other follow-up and the results of those recalls visits. Results: Results of screening for only the mobile vehicles are presented below, with emphasis on comparing results from tomosynthesis mammography (DBT) to those from standard digital mammography (DM). Chi-Squared tests were used to calculate p values. For the meeting presentation the numbers will be updated to include more patients screened and demographics and area health measures will be included. 4,619 patients were given mammograms with the DM machine, and (since it is new and has not long been in service) 2,731 with DBT. The number of recalls for additional study was 713 (15.4%) with DM and 131 (4.8%), with DBT. DBT resulted in significantly fewer recalls, p&amp;lt;0.0001. The number of cancers detected by DM was 20 (2.8% of recalls) and by DBT was 15 (11.5% of recalls). Again this is highly significant, p&amp;lt;0.0002. Conclusion: tomosynthesis mammograpy is significantly better at reducing unnecessary recalls, and at dectecting breast cancer than usual digital mammography. Recall visits are an especially serious burden on underserved populations with many access to care issues. Tomosynthesis mammography requires a more expensive machine, but its value, especially in minority underserved populations which are hard to reach and have major access to cancer care issues is undeniable. Citation Format: Jerry W. McLarty, Jennifer Lance, Towanno Collins, Sharon Grubbs, Stacey Massey, Nelson Luraguiz. Screening outcomes of digital Breast tomosynthesis versus digital mammography in an underserved population with multiple disparities. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C74.

Invasive breast cancer: Digital breast tomosynthesis versus full-field digital mammography

Invasive breast cancer: Digital breast tomosynthesis versus full-field digital mammography

RELATIONSHIP BETWEEN RADIATION DOSE AND IMAGE QUALITY IN DIGITAL BREAST TOMOSYNTHESIS.

This phantom-based study aimed to examine radiation dose from digital breast tomosynthesis (DBT) and digital mammography (DM) and to assess the potential for dose reductions for each modality. Images were acquired at 10-60 mm thicknesses and four dose levels and mean glandular dose was determined using a solid-state dosemeter. Eleven readers assessed image quality and compared simulated lesions with those on a reference image, and the data produced was analysed with the Friedman and Wilcoxon signed-rank tests. For a phantom thickness of 50 mm (typical breast thickness), DBT dose was 13 % higher than DM, but this differential is highly dependent on thickness. Visibility of masses was equal to a reference image (produced at 100 % dose) when dose was reduced by 75 and 50 % for DBT and DM. For microcalcifications, visibility was comparable with the reference image for both modalities at 50 % dose. This study highlighted the potential for reducing dose with DBT.

Diagnostic value in the evaluation of mass-like lesions in dense breasts: digital breast tomosynthesis versus conventional mammography

Objective To compare the diagnostic value of digital breast tomosynthesis (DBT) versus digital mammography (DM) in the evaluation mass like lesions in dense breasts. Methods Eight hundred and fifty eight patients, who had DBT and DM, with breast diseases confirmed by pathology were retrospectively reviewed. The breast density and the imaging features were classified according to the standard of American College of Radiology(2013) and breast imaging reporting and data system (BI-RADS) scores. Six hundred and thirty one patients with mass lesions in dense breasts were chosen to included. All 631 patients had DM of both breasts and DBT of affected breast prior to mastectomy. Pathological results were used as the golden standard. Detection rate and diagnostic accuracy of masses, sensitivity and specificity of diagnosis, false negative and recall rates, the margins and spicules and BI-RADS category were calculated. The detection rate and diagnostic accuracy, the margins and spicules of masses were compared with Chi-square test, the BI-RADS scores were analyzed with rank test. Results With DBT, average detection rate increased from 77.3% (488/631) to 84.3% (532/631), average diagnostic accuracy rate increased from 73.4% (463/631) to 82.3% (519/631) ,with statistical significant difference between groups (χ2=27.191,36.890,P<0.01).Sensitivity for DBT and DM were 68.1% (205/301) and 58.8% (177/301) , respectively. Specificity for DBT and DM were 95.2% (314/330) and 86.7% (286/330) , respectively. Recall rate for DBT and DM were 3.6% (23/631) and 9.8% (62/631) , respectively. One hundred and seventy two cases and 75 cases with circumscribed masses of benign cases were detected by DBT and DM, respectively. One hundred and eighty-two cases and 115 cases with spiculated masses of malignant cases were detected by DBT and DM, respectively, with statistical significant difference between groups (χ2=70.471 and 21.707, P<0.01). Of 330 malignant cases, the numbers of BI-RADS category 0, 2, 3, 4A, 4B, 4C, 5 on DM images were 19,4,8,13,52,93,141, respectively, the numbers on DBT images were 3,1,7,5,52,83,179, respectively, with statistical significant difference (Z=-2.235,P=0.025) . Of 301 benign cases, the number of BI-RADS category 0, 2, 3, 4A, 4B, 4C, 5 on DM images were 43,10,60,117,58,11,2, respectively, the number on DBT images were 20,4,64,150,55,7,1, respectively, with no statistical significant difference between groups (Z=-1.846,P=0.065) . Conclusion DBT significantly improves the detection of mass-like lesions in dense breasts, display of mass margin and architectural distortion of surrounding tissue. Key words: Breast neoplasms; Mammography; Digital breast tomosynthesis

Diagnostic value of digital breast tomosynthesis plus full-field digital mammography in breast disease

Objective To investigate the diagnostic value of digital breast tomosynthesis (DBT) plus full-field digital mammography (FFDM) in benign and malignant breast disease. Methods The prospective study enrolled 46 consenting women with a clinical suspicious of breast lesion confirmed by pathology. All the patients underwent DBT, FFDM and dedicated breast magnetic resonance image (DB-MRI) examinations before surgery or biopsy. To observe the manifestation of breast disease in different examinations according to breast imaging reporting and data system (BI-RADS), and to evaluate the visibility grade of disease between DBT plus FFDM and FFDM alone. Using receiving operating characteristic (ROC) and Z test to analysis the diagnostic efficiency of three examinations. Results Forty-six cases included 14 benign cases and 32 malignant cases. Compared with FFDM, 35 cases showed increased visibility in DBT plus FFDM, that the malignant lesion manifested mass with speculated and architectural distortion(23/27) and the benign lesion manifested mass with halo sign(6/8). Eleven cases didn't show increase visibility in both DBT plus FFDM and FFDM alone. The ration of BI-RADS 0 in FFDM was 23.9%(11/46), meanwhile in other two examination were 0. The ration of BI-RADS 3 in DBT plus FFDM was the lowest(6.5%, 3/46). When the lesion in DBT plus FFDM showed mass or speculated, in MRI showed similar morphology with mass or mass-like enhancement. According pathology as the gold standard, excluded 11 cases with BI-RADS 0 in FFDM, there was significant statistical difference between DBT plus FFDM and FFDM alone in 35 cases (Z=2.132, P=0.033) to differentiate benign and malignant breast disease, the area of ROC curve were respectively 0.955, 0.878. There is no statistical difference between DBT plus FFDM and MRI in 46 cases (Z=0.502, P=0.616), the area of ROC curve were respectively 0.887, 0.908. Conclusion DBT combined with FFDM can improve both detection of breast lesion and diagnostic efficiency, while the performance value between DBT and MRI are equal. Key words: Breast neoplasms; Mammography; Magnetic resonance imaging

MODERN CAPABILITIES OF BREAST PATHOLOGY DIAGNOSTICS

Every year more than 1 million new cases of breast cancer are being recorded worldwide. Choice of appropriate tactics of treatment depends on the timely diagnosis and correct assessment of the prevalence of cancer. The algorithm of patient»s examination includes clinical examination, X-ray mammography and ultrasonic diagnosis of breast. However, this is not sufficient for a complete interpretation of the patient»s condition in case of non-palpable breast formations, ambiguous interpretation of imaging under structural changes, increased density of breast tissue, etc. In this regard, the introduction of new technologies and their evaluation in terms of practicality is a logical and developing method of early diagnosis of breast pathology. One of the methods that enables enhancing the information capability of ultrasonic diagnosis of breast is elastography. It allows for the differential diagnosis of benign and malignant changes not only in the breast tissue, but also in the areas of regional lymph drainage. Promising method of modern diagnostic breast care is digital mammography tomosynthesis. However, in spite of the first and very optimistic data, this technique is still far from standard. Complex diagnostics of breast pathology, in addition to clinical data and imaging results, are based on information obtained from biopsies. At the present stage core-biopsy is considered as the best way of verification, where the resulting material is subjected to immunohistochemical studies. Thus , the spectrum of diagnostic capabilities is constantly expanding. Highly informative techniques included in the daily practice today enable clinicians to achieve optimal results in curing even greater number of patients.

Digital breast tomosynthesis

In digital breast tomosynthesis several low dose mammograms are acquired from different angles to calculate thin slices of synthetic mammograms from algorithms. Similar to computed tomography and magnetic resonance imaging, breast tomosynthesis provides breast images which are virtually free from superimposition. This is in particular important in cases of high mammographic density to differentiate real masses and architectural distortions from the overlying parenchyma. In comparison to full field digital mammography tomosynthesis can improve the cancer detection rate and reduce the recall rate. The limitations of tomosynthesis are the higher radiation dose and the longer reporting time compared to full field digital mammography. Until the radiation dose can be significantly reduced it is advisable to use tomosynthesis in addition to full field digital mammography primarily for the assessment of suspicious mammographic findings and not for breast cancer screening.

Effect of radiologists' experience on breast cancer detection and localization using digital breast tomosynthesis.

The objectives are To to compare the diagnostic performance of combined digital breast tomosynthesis (DBT) and digital mammography (DM) with that of DM alone, as a function of radiologists' experience with DBT. Ethical committee approval was obtained. Fifty cases (27 cancer, 23 normal), each containing both digital mammography (DM) and digital breast tomosynthesis (DBT) images, were reviewed by 26 radiologists, divided into three groups according to level of experience with DBT (none, workshop experience, and clinical experience). The radiologists' diagnostic performance using DM was compared with that using DM + DBT, and evaluated by area under receiver-operating characteristic curve (AUC), jackknife free-response receiver-operator characteristics figure of metric (JAFROC FOM), sensitivity, location sensitivity, and specificity. For all readers combined, performance using DM + DBT was significantly higher than for DM alone by both AUC (0.788 vs 0.681, p < 0.001) and JAFROC FOM (0.745 vs 0.621, p < 0.001). Similar results were obtained for readers with no DBT experience (AUC 0.775 vs 0.682, p = 0.004; JAFROC FOM 0.695 vs 0.603, p = 0.016) and with clinical DBT experience (AUC 0.789 vs 0.681, p = 0.042; and JAFROC FOM 0.764 vs 0.632, p = 0.031). Addition of DBT to DM significantly improves radiologists' diagnostic performance whether or not they have prior DBT experience. • Adding DBT to DM increased the number of detected cancers • DBT + DM led to more accurate localization of breast cancers than DM • Addition of DBT improved radiologists' performance regardless of prior DBT experience • High-volume radiologists with different DBT experience levels performed similarly on DM + DBT.