Jaime Geisel

Comparison of Tomosynthesis Plus Digital Mammography and Digital Mammography Alone for Breast Cancer Screening

PURPOSE To compare screening recall rates and cancer detection rates of tomosynthesis plus conventional digital mammography to those of conventional digital mammography alone. MATERIALS AND METHODS All patients presenting for screening mammography between October 1, 2011, and September 30, 2012, at four clinical sites were reviewed in this HIPAA-compliant retrospective study, for which the institutional review board granted approval and waived the requirement for informed consent. Patients at sites with digital tomosynthesis were offered screening with digital mammography plus tomosynthesis. Patients at sites without tomosynthesis underwent conventional digital mammography. Recall rates were calculated and stratified according to breast density and patient age. Cancer detection rates were calculated and stratified according to the presence of a risk factor for breast cancer. The Fisher exact test was used to compare the two groups. Multivariate logistic regression was used to assess the effect of screening method, breast density, patient age, and cancer risk on the odds of recall from screening. RESULTS A total of 13 158 patients presented for screening mammography; 6100 received tomosynthesis. The overall recall rate was 8.4% for patients in the tomosynthesis group and 12.0% for those in the conventional mammography group (P < .01). The addition of tomosynthesis reduced recall rates for all breast density and patient age groups, with significant differences (P < .05) found for scattered fibroglandular, heterogeneously dense, and extremely dense breasts and for patients younger than 40 years, those aged 40-49 years, those aged 50-59 years, and those aged 60-69 years. These findings persisted when multivariate logistic regression was used to control for differences in age, breast density, and elevated risk of breast cancer. The cancer detection rate was 5.7 per 1000 in patients receiving tomosynthesis versus 5.2 per 1000 in patients receiving conventional mammography alone (P = .70). CONCLUSION Patients undergoing tomosynthesis plus digital mammography had significantly lower screening recall rates. The greatest reductions were for those younger than 50 years and those with dense breasts. A nonsignificant 9.5% increase in cancer detection was observed in the tomosynthesis group.

Early Clinical Experience with Digital Breast Tomosynthesis for Screening Mammography

PURPOSE To examine recall rates from screening mammography and the mammographic findings that caused recall in women who underwent digital breast tomosynthesis with conventional mammography (referred to as two-dimensional [ 2D two-dimensional ] with three-dimensional [ 3D three-dimensional ] imaging [ 2D two-dimensional + 3D three-dimensional ]) and in women who underwent conventional mammography alone (referred to as 2D two-dimensional ). MATERIALS AND METHODS This was an institutional review board-approved, HIPAA-compliant study with waivers of informed consent. A retrospective review of 2D two-dimensional + 3D three-dimensional and 2D two-dimensional screening mammograms from August 1, 2011, to December 31, 2012, was performed. Recall rates and abnormalities that caused recall were compared by controlling for differences in patient age, breast density, and risk factors. Cancer detection rate was assessed from this time period and from 1 year before the introduction of tomosynthesis for a historic control. RESULTS This study included 17 955 screening mammograms; of the total, there were 8591 (47.8%) 2D two-dimensional + 3D three-dimensional screening examinations and 9364 (52.2%) 2D two-dimensional examinations. The recall rate was 7.8% (671 of 8592) for 2D two-dimensional + 3D three-dimensional and 12.3% (1154 of 9364) for 2D two-dimensional (P < .0001); the rate of recall was 36.6% lower in the 2D two-dimensional + 3D three-dimensional group than in the 2D two-dimensional group. Recall rates for the 2D two-dimensional + 3D three-dimensional group were significantly lower for patients with asymmetries, ( 2D two-dimensional + 3D three-dimensional vs 2D two-dimensional , 3.1% [267 of 8591] vs 7.4% [689 of 9364], respectively; P < .0001) and calcifications ( 2D two-dimensional + 3D three-dimensional vs 2D two-dimensional , 2.4% [205 of 8591] vs 3.2% [297 of 9364], respectively; P = .0014). For patients with masses and architectural distortion, the difference in recall rates was not significant (masses: 2D two-dimensional + 3D three-dimensional vs 2D two-dimensional , 2.5% [215 of 8591] vs 2.5% [237 of 9364], respectively; P = .90; architectural distortion: 2D two-dimensional + 3D three-dimensional vs 2D two-dimensional , 0.68% [58 of 8591] vs 0.69% [65 of 9364]; P = .88). Cancer detection was highest in the 2D two-dimensional + 3D three-dimensional group at 5.9 cancers per 1000 examinations, with 5.7 cancers per 1000 examinations in the concurrent 2D two-dimensional group, and 4.4 cancers per 1000 examinations in the historic control. CONCLUSION Use of tomosynthesis ( 2D two-dimensional + 3D three-dimensional ) compared with conventional mammography ( 2D two-dimensional ) is associated with a lower recall rate of screening mammography, most often for asymmetries.

Breast Imaging of the Pregnant and Lactating Patient: Imaging Modalities and Pregnancy-Associated Breast Cancer

OBJECTIVE The purpose of this article is to review key clinical, histologic, and imaging features of pregnancy-associated breast cancer. A discussion of imaging modalities, including mammography, ultrasound, and MRI, and imaging-based interventions available for evaluating this population is provided. CONCLUSION Successful detection of pregnancy-associated breast cancer requires knowledge of key clinical and imaging features of pregnancy-associated breast carcinoma and selection of the appropriate imaging workup and intervention.

Breast Imaging of the Pregnant and Lactating Patient: Physiologic Changes and Common Benign Entities

OBJECTIVE The purpose of this article is to review key clinical, histologic, and imaging features of expected physiologic changes within the breast and common benign breast disease in the pregnant and lactating patient. CONCLUSION A thorough understanding of expected physiologic changes and common benign breast abnormalities of pregnancy and lactation is required to differentiate these entities from pregnancy-associated breast cancer and to appropriately guide patient management.

Tomosynthesis in the Diagnostic Setting: Changing Rates of BI-RADS Final Assessment over Time

Purpose To evaluate the effect of tomosynthesis in diagnostic mammography on the Breast Imaging Reporting and Data System (BI-RADS) final assessment categories over time. Materials and Methods This retrospective study was approved by the institutional review board. The authors reviewed all diagnostic mammograms obtained during a 12-month interval before (two-dimensional [2D] mammography [June 2, 2010, to June 1, 2011]) and for 3 consecutive years after (tomosynthesis year 1 [2012], tomosynthesis year 2 [2013], and tomosynthesis year 3 [2014]) the implementation of tomosynthesis. The requirement to obtain informed consent was waived. The rates of BI-RADS final assessment categories 1-5 were compared between the 2D and tomosynthesis groups. The positive predictive values after biopsy (PPV3) for BI-RADS category 4 and 5 cases were compared. The mammographic features (masses, architectural distortions, calcifications, focal asymmetries) of lesions categorized as probably benign (BI-RADS category 3) and those for which biopsy was recommended (BI-RADS category 4 or 5) were reviewed. The χ(2) test was used to compare the rates of BI-RADS final assessment categories 1-5 between the two groups, and multivariate logistic regression analysis was performed to compare all diagnostic studies categorized as BI-RADS 3-5. Results There was an increase in the percentage of cases reported as negative or benign (BI-RADS category 1 or 2) with tomosynthesis (58.7% with 2D mammography vs 75.8% with tomosynthesis at year 3, P < .0001). A reduction in the percentage of probably benign (BI-RADS category 3) final assessments also occurred (33.3% with 2D mammography vs 16.4% with tomosynthesis at year 3, P < .0001). Although the rates of BI-RADS 4 or 5 assessments did not change significantly with tomosynthesis (8.0% with 2D mammography vs 7.8% with tomosynthesis at year 3, P = .2), there was a significant increase in the PPV3 (29.6% vs 50%, respectively; P < .0001). These trends increased during the 3 years of tomosynthesis use. Conclusion Tomosynthesis in the diagnostic setting resulted in progressive shifts in the BI-RADS final assessment categories over time, with a significant increase in the proportion of studies classified as normal, a continued decrease in the rate of studies categorized as probably benign, and improved diagnostic confidence in biopsy recommendations. (©) RSNA, 2016.

The Role of Ultrasound in Breast Cancer Screening: The Case for and Against Ultrasound

Mammography is the gold standard for breast cancer screening. However, with increasing awareness among patients and health care providers of mammography limitations especially in dense breasts, supplemental screening for breast cancer with ultrasound and magnetic resonance imaging has been expanding. The roles of both in screening need to be re-examined. This article reviews the efficacy, utility, and feasibility of ultrasound as a screening tool for the early detection of occult breast cancer.

Breast Tomosynthesis: a Replacement or an Adjunct to Conventional Diagnostic Mammography?

Mammography is the current standard for breast cancer screening and diagnosis. Conventional mammography, a 2D representation of a 3D structure, is limited in sensitivity and specificity by overlapping tissue. Digital breast tomosynthesis, or 3D mammography, overcomes this major limitation. Since it was approved in the US as an adjunct to 2D mammography in February 2011, digital breast tomosynthesis has become more widely available. Review of the limited world literature on digital breast tomosynthesis shows it to be a promising technique increasing the accuracy of mammography by improving detection, localization, and characterization of findings. Here we review the potential benefits and disadvantages of digital breast tomosynthesis for screening and diagnosis, and describe the latest advances in tomosynthesis technology, including synthesized 2D imaging that may render the conventional 2D mammogram obsolete.

A Rare Presentation of Rosai-Dorfman Disease as a Breast Mass.

A 41-year-old female presented for diagnostic baseline mammogram for a palpable breast mass which she first noticed 6 months ago. She did not have any other clinical symptoms. Digital breast tomosynthesis along with 2D synthesized imaging and targeted ultrasound showed a heterogeneous lobulated mass versus a conglomerate of three contiguous masses in the right breast at the 10–11 o’clock position middle depth which correlated with the palpable lesion (Fig. 1). Findings were suspicious for multicentric breast cancer. Ultrasound guided biopsy was performed of the dominant component of the mass. Pathology review of the biopsy was interpreted as an intramammary lymph node with reactive changes which was thought to be discordant. The decision was made to surgically remove the discordant area. An ultrasound guided wire localization was performed using two wires to bracket the area in the right breast at the 10 o’clock position (Fig. 2). The gross pathologic specimen was received en bloc