Rationale and Objectives
The role of digital breast tomosynthesis (DBT) in evaluating palpable abnormalities has not been evaluated and its accuracy compared to 2D mammography is unknown. The purpose of this study was to evaluate combined 2D mammography, DBT, and ultrasound (US) at palpable sites.
Materials and Methods
Two breast imagers reviewed blinded consecutive cases with combined 2D mammograms and DBT examinations performed for palpable complaints. By consensus, 2D and DBT findings were recorded and compared to US. Patient characteristics, demographics, subsequent workup, and outcome were recorded.
Results
A total of 229 sites in 188 patients were included, with 50 biopsies performed identifying 18 cancers. All 18 cancers were identified on 2D and US, whereas 17 cancers were identified on DBT. Cancer detection sensitivities for 2D, DBT, and US were 100.0%, 94.4%, and 100.0%. The negative predictive value, when combined with US, was 100% for both. The sensitivity and the specificity for both benign and malignant findings with 2D and DBT were 70.5% versus 75.4% ( P = 0.07) and 95.3% versus 99.1% ( P = 0.125). Palpable findings not identified by 2D and DBT were smaller than those identified (11.5 ± 8.3 mm vs 23.9 ± 12.8 mm, P < 0.001). Patients with dense breasts were more likely to have mammographically occult findings than patients with nondense breasts (27.4% vs 8.3%).
Conclusions
DBT did not improve cancer detection over 2D or US. Both mammographic modalities failed to identify sonographically confirmed findings primarily in dense breasts. The diagnostic use of DBT at palpable sites provided limited benefit over combined 2D and US. When utilizing DBT, US should be performed to adequately characterize palpable sites.
Introduction
Palpable abnormalities of the breast are one of the most common indications for which patients present for diagnostic breast imaging. Although most palpable abnormalities are benign, new palpable findings are a common presenting sign of breast cancer . Physical examination of the breast may be difficult as breasts have varying volumes of parenchymal tissues and fat. Previous research has shown that cystic causes of palpable abnormalities cannot be readily distinguished from solid masses by physical examination, and significant disagreement often occurs in the characterization of palpable breast masses even among experienced examiners .
Many breast masses do not exhibit definitive physical findings, and diagnostic breast imaging is often required to differentiate between benign and malignant causes of palpable abnormalities. The American College of Radiology (ACR) publishes appropriateness criteria guiding the recommended imaging examinations performed in the diagnosis of palpable breast masses . Typically, diagnostic imaging evaluations include some combination of mammography and targeted ultrasound (US) depending on patient age. Diagnostic mammography is recommended as the initial imaging step for women aged 40 or greater with palpable breast masses. Women aged 30–39 may either utilize diagnostic mammography or targeted US initially, depending on physician or practice preference. Imaging findings, which are not definitively benign on initial imaging evaluation, typically require additional evaluation with the alternate modality. Women under 30 years of age typically undergo US initially with mammography reserved to clarify indeterminate features or for further evaluation of suspicious findings.
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Materials and Methods
Study Population
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Image Interpretation and Acquisition
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Data Analysis
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Results
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Table 1
Clinical Variables
Clinical Variables Patients 188 Palpable events 229 Age (y), mean ± SD 44.7 ± 11.3 Patients with dense breasts \* 124 (66) Patients with nondense breasts \* 64 (34) Palpable events that underwent diagnostic sampling 50 (21.8) Mean follow-up (mo), mean ± SD † 25.7 ± 12.1
SD, standard deviation.
All data except age and mean follow-up reported as the number (%) of patients.
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Table 2
Summary of Results of All Imaging Interpretations
2D Mammography 3D Mammography (DBT) Ultrasound Palpable Cases Cancers − − − 102 (44.5) 0 (0) − −+ 29 (12.7) 0 (0) −+ − 0 (0) 0 (0) −++ 7 (3.1) 0 (0)+ − − 4 (1.7) 0 (0)+ −+ 1 (0.4) 1 (5.6) \* ++ − 1 (0.4) 0 (0)+++ 85 (37.1) 17 (94.4)
DBT, digital breast tomosynthesis.
The + symbol denotes a positive finding was identified and described. The − symbol denotes no finding was identified. All data reported as the number (%) of cases.
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Discussion
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Conclusions
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