Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2018; 28(01): 115-122
DOI: 10.4103/ijri.IJRI_107_17
Breast Imaging

Comparing the diagnostic efficacy of full field digital mammography with digital breast tomosynthesis using BIRADS score in a tertiary cancer care hospital

Divya Singla
Department of Radiology, Dr. B.R. Ambedkar Hospital, Rohini, New Delhi
,
Arvind K. Chaturvedi
Department of Radiology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi
,
Abhinav Aggarwal
Department of Radiology, City X‑Ray and Scan Clinic, Dwarka, India
,
S. A. Rao
Department of Radiology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi
,
Dibyamohan Hazarika
Department of Radiology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi
,
Vivek Mahawar
Department of Radiology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi
› Author Affiliations
Subject Editor: Financial support and sponsorship Nil.
› Further Information
   Permissions and Reprints

Abstract

Introduction: Breast cancer is one of the leading cancers in females worldwide, and its incidence has been rising at an exponential pace in the last 10 years even in India. Mammography has been the mainstay for detection of breast cancer over decades and has gradually advanced from screen film to full-field digital mammography. Recently, tomosynthesis has evolved as an advanced imaging investigation for early diagnosis of breast lesions in both diagnostic and screening settings. Aim of Study: To compare and evaluate the impact of digital breast tomosynthesis (DBT) compared to full-field digital mammography (FFDM) in the interpretation of BIRADS score in both diagnostic and screening settings. Settings and Design: A 1-year prospective longitudinal study was conducted in the Department of Radio-diagnosis in our institute using Hologic Selenia Dimensions for mammography as well as tomosynthesis. Materials and Methods: One hundred women known or suspected (opportunistic screening) for breast cancer were evaluated either with FFDM alone or both FFDM and DBT. Sensitivity, specificity, positive predictive value, negative predictive value, and P value were used to assess the various diagnostic criteria in our study. Results: Addition of DBT to FFDM results in a statistically significant increase in the sensitivity, specificity, and positive predictive value, and a statistically significant decrease in the false positive rates. Similar results were noted in both diagnostic and screening cases. It was observed that, in most cases, i.e. a total of 47, DBT did not change the BIRADS scoring; however, its addition increased the diagnostic confidence. BIRADS was upgraded and downgraded in 14 and 31 cases, respectively, with the addition of DBT to FFDM. New lesions were seen with addition of DBT to FFDM in 8 cases. Conclusion: Addition of DBT to FFDM results in increase in sensitivity, specificity, positive predictive value, and a statistically significant decrease in false positive rates in both diagnostic and screening cases. As addition of tomosynthesis results in a significant decrease in recall rate, it should be added, at least, in all screening mammography programs.

Keywords

Breast cancer - mammography - opportunistic screening - tomosynthesis


Publication History

Article published online:
26 July 2021

© 2018. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 International Agency for Research on Cancer. GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence worldwide [Internet]. 2012 [Accessed on June 2015]. Available from: http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx
    PubMedGoogle Scholar
  • 2 Shtern F. Digital mammography and related technologies: A perspective from the National Cancer Institute. Radiology 1992; 183: 629-30
    CrossrefPubMedGoogle Scholar
  • 3 Humphrey LL, Helfand M, Chan BK, Woolf SH. Breast cancer screening: A summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2002; 137: 347-60
    CrossrefPubMedGoogle Scholar
  • 4 Fletcher SW, Elmore JG. Clinical practice. Mammographic screening for breast cancer. N Engl J Med 2003; 348: 1672-80
    CrossrefPubMedGoogle Scholar
  • 5 Rafferty EA. Digital mammography: Novel applications. Radiol Clin North Am 2007; 45: 831-43
    CrossrefPubMedGoogle Scholar
  • 6 Lewin JM, Niklason L. Advanced applications of digital mammography: Tomosynthesis and contrast-enhanced digital mammography. Semin Roentgenol 2007; 42: 243-52
    CrossrefPubMedGoogle Scholar
  • 7 Poplack SP, Tosteson TD, Kogel CA, Nagy HM. Digital breast tomosynthesis: Initial experience in 98 women with abnormal digital screening mammography. AJR Am J Roentgenol 2007; 189: 616-23
    CrossrefPubMedGoogle Scholar
  • 8 Andersson I, Ikeda DM, Zackrisson S, Ruschin M, Svahn T, Timberg P. et al. Breast tomosynthesis and digital mammography: A comparison of breast cancer visibility and BIRADS classification in a population of cancers with subtle mammographic findings. Eur Radiol 2008; 18: 2817-25
    CrossrefPubMedGoogle Scholar
  • 9 Gur D, Abrams GS, Chough DM, Ganott MA, Hakim CM, Perrin RL. et al. Digital breast tomosynthesis: Observer performance study. AJR Am J Roentgenol 2009; 193: 586-91
    CrossrefPubMedGoogle Scholar
  • 10 Baker JA, Lo JY. Breast tomosynthesis: State-of-the-art and review of the literature. Acad Radiol 2011; 18: 1298-310
    CrossrefPubMedGoogle Scholar
  • 11 Diekmann F, Bick U. Breast tomosynthesis. Semin Ultrasound CT MR 2011; 32: 281-7
    CrossrefPubMedGoogle Scholar
  • 12 Helvie MA. Digital mammography imaging: Breast tomosynthesis and advanced applications. Radiol Clin North Am 2010; 48: 917-29
    CrossrefPubMedGoogle Scholar
  • 13 Rafferty EA. Breast tomosynthesis. Semin Breast Dis 2006; 9: 111-8
    CrossrefGoogle Scholar
  • 14 Uematsu T. The emerging role of breast tomosynthesis. Breast Cancer 2013; 20: 204-12
    CrossrefPubMedGoogle Scholar
  • 15 Feng SS, Sechopoulos I. Clinical digital breast tomosynthesis system: Dosimetric characterization. Radiology 2012; 263: 35-42
    CrossrefPubMedGoogle Scholar
  • 16 Hakim CM, Chough DM, Ganott MA, Sumkin JH, Zuley ML, Gur D. Digital breast tomosynthesis in the diagnostic environment: A subjective side-by-side review. AJR Am J Roentgenol 2010; 195: W172-6
    CrossrefPubMedGoogle Scholar
  • 17 Noroozian M, Hadjiiski L, Rahnama-Moghadam S, Klein KA, Jeffries DO, Pinsky RW. et al. Digital breast tomosynthesis is comparable to mammographic spot views for mass characterization. Radiology 2012; 262: 61-8
    CrossrefPubMedGoogle Scholar
  • 18 Haas BM, Kalra V, Geisel J, Raghu M, Durand M, Philpotts LE. Comparison of tomosynthesis plus digital mammography and digital mammography alone for breast cancer screening. Radiology 2013; 269: 694-700
    CrossrefPubMedGoogle Scholar
  • 19 Rose SL, Tidwell AL, Bujnoch LJ, Kushwaha AC, Nordmann AS, Sexton Jr. R. Implementation of breast tomosynthesis in a routine screening practice: An observational study. AJR Am J Roentgenol 2013; 200: 1401-8
    CrossrefPubMedGoogle Scholar
  • 20 Skaane P, Bandos AI, Gullien R, Eben EB, Ekseth U, Haakenaasen U. et al. Prospective trial comparing Full field digital mammography (FFDM) versus combined FFDM and tomosynthesis in a population based screening programme using independent double reading with arbitration. Eur Radiol 2013; 23: 2061-71
    CrossrefPubMedGoogle Scholar
  • 21 Gilbert FJ, Tucker L, Gillan MG, Willsher P, Cooke J, Duncan KA. et al. The TOMMY trial: a comparison of TOMosynthesis with digital MammographY in the UK NHS Breast Screening Programme-a multicentre retrospective reading study comparing the diagnostic performance of digital breast tomosynthesis and digital mammography with digital mammography alone. Health Technol Assess 2015; 19: i-xxv
    CrossrefPubMedGoogle Scholar
  • 22 Gennaro G, Toledano A, Di Maggio C, Baldan E, Bezzon E, La Grassa M. et al. Digital breast tomosynthesis versus digital mammography: A clinical performance study. Eur Radiol 2010; 20: 1545-53
    CrossrefPubMedGoogle Scholar
  • 23 Rafferty EA, Park JM, Philpotts LE, Poplack SP, Sumkin JH, Halpern EF. et al. Assessing radiologist performance using combined digital mammography and breast tomosynthesis compared with digital mammography alone: Results of a multicentre, multireader trial. Radiology 2013; 266: 104-13
    CrossrefPubMedGoogle Scholar
  • 24 Spangler ML, Zuley ML, Sumkin JH, Abrams G, Ganott MA, Hakim C. et al. Detection and classification of calcifications on digital breast tomosynthesis and 2D digital mammography: A comparison. AJR Am J Roentgenol 2011; 196: 320-4
    CrossrefPubMedGoogle Scholar