Rationale and Objectives
This study compared a novel photon-counting breast computed tomography (pcBCT) system with digital mammography (DM) and digital breast tomosynthesis (DBT) systems. For this reason, surgical specimens were examined with all three techniques and rated by three observers.
Materials and Methods
A total of 30 surgical specimens were investigated with DM, DBT, and pcBCT; the associated images were shown to three experienced radiologists. Findings (22 microcalcifications and 23 mass lesions) were recorded and compared to the results of the pathological examination. Sensitivity and specificity for detection of microcalcifications and lesions were calculated and displayed using receiver operating characteristic curves.
Results
Sensitivity for microcalcifications was 82% for DM, 70% for DBT, and 85% for pcBCT. Specificity for microcalcifications was 71% for DM, 75% for DBT, and 83% for pcBCT. Sensitivity for lesions was 45% for DM, 62% for DBT, and 65% for pcBCT. Specificity for lesions was 76% for DM, 62% for DBT, and 76% for pcBCT.
Conclusions
pcBCT showed a comparable or superior performance compared to the clinically approved DM and DBT systems. Mass lesion detectability can be increased further by the use of contrast media.
Introduction
Breast cancer is the most frequent solid malignant tumor among women in industrial nations. In 2012, breast cancer had an incidence of 464,000 cases in Europe and was the leading cause of cancer death in women . Early detection is essential to reduce the mortality rate. Each millimeter of tumor diameter is associated with a percent higher chance of death . For this reason, screening programs have been established in most European countries .
Digital mammography (DM) is the workhorse of breast imaging but weakens its effectiveness in dense breast tissue due to superposition of tissue structures. Mammographic sensitivity in lesion detection for fatty breasts rises up to 98% but drops down to 48%–30% in very dense breast tissue . On the other hand, studies reported up to a fivefold increased breast cancer risk in women with dense breast tissue . Sensitivity of DM has improved significantly with the additional use of digital breast tomosynthesis (DBT), which has a slightly higher radiation dose compared to conventional mammography . The sensitivity of DBT alone was 43% higher than mammography in clinical trials . Recall rates in screening programs could be reduced if DBT was conducted in addition to mammography . Unfortunately, problems occurred in the detection of calcifications and sensitivity was higher for DM than for DBT in some studies .
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Materials and Methods
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Results
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Table 1
Overview of Pathological Findings in Lumpectomy and Mastectomy Specimens
Lumpectomy Mastectomy Without Calcifications With Calcifications Without Calcifications With Calcifications IC without DCIS 0 1 3 0 IC with DCIS 2 3 4 3 Pure DCIS 0 2 1 4 ADH 1 0 0 0 Fibrocystic changes 2 3 3 0
ADH, atypical ductal hyperplasia; DCIS, ductal carcinoma in situ; IC, invasive carcinoma.
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Table 2
Average Reading Time for DM, DBT, and pcBCT
Reading Time (s) DM DBT pcBCT Reader 1 77 122 131 Reader 2 61 54 83 Reader 3 66 63 119
DBT, digital breast tomosynthesis; DM, digital mammography; pcBCT, photon-counting breast computed tomography.
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Discussion
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