BACKGROUND:
Breast cancer is comments type of cancer in women, and the second leading cause of death worldwide. Mammography had been the cornerstone for breast cancer diagnosis throughout the years. Digital breast tomosynthesis had been developed as an advanced method for early diagnosing a breast lesion and found to have promising results in both screening and diagnostic measures more importantly in dense and previously treated breasts.
OBJECTIVE:
To evaluate digital breast tomosynthesis (DBT) compared to digital mammography for the detection of different breast lesions and interpretations of BIRADS IV and V scoring in different breast densities.
PATIENTS AND METHODS:
A prospective cohort conducted at Oncology teaching hospital in Medical City teaching complex in Baghdad for the period of 8 months from March 2021 to November 2021, included 101 suspicious breast lesions (BIRADS IV and V) was undergone Digital mammography and Digital Breast tomosynthesis, and diagnosis confirmed with FNA cytology and/or US guided core needle biopsy.
Statistical analysis was done using IBM SPSS software version 25, statistical comparisons were performed using the Chi-square test or fisher’s exact test. Significance was defined as a P value less than 0.05.
RESULTS:
The results obtained from the study regarding the diagnostic performance of each modality showed that higher sensitivity for DBT 100% in comparison to DM 69.2%, however the specificity for DBT was not measured because of absence of true negative cases as the result of the selection criteria, the accuracy of DBT was higher for ACR a (100% vs 72.7%) and c (54.5 vs 45.4%) than mammography, However, they were the same for ACR b, for ACR d we have only 2 cases.
Additionally, we found that change in BI-RADS scoring with BDT was 12/24 (50%) in dense breast categories (ACR c and d) while in fatty and scattered fibroglandular breasts (ACR a and b), it was 44/77 (57%).
CONCLUSION:
These findings indicate that tomosynthesis is superior to mammography in terms of sensitivity at all breast densities, but notably at greater densities. It is advantageous because, unlike mammography, which produces two-dimensional images, it eliminates obscuring breast tissue and provides a higher resolution of the internal breast structures. And this will result in a decrease in false positive results, recalls, and special mammographic views, as well as a decrease in radiation exposure and costs.
|
- Tabar L, Vitak B, Chen HH, Yen MF, Duffy SW, Smith RA. Beyond randomized controlled trials: organized mammographic screening substantially reduces breast carcinoma mortality. Cancer. 2001;91:1724-31.
- Tabar L, Vitak B, Chen TH, Yen AM, Cohen A, Tot T, et al. Swedish two-county trial: impact of mammographic screening on breast cancer mortality during 3 decades. Radiology. 2011;260:658-63.
- Thigpen D, Kappler A, Brem R. Response to Comment on Thigpen D. et al. The Role of Ultrasound in Screening Dense Breasts-A Review of the Literature and Practical Solutions for Implementation. Diagnostics 2018, 8, 20. Diagnostics (Basel). 2018;8.
- Berg WA. Beyond standard mammographic screening: mammography at age extremes, ultrasound, and MR imaging. Radiol Clin North Am. 2007;45:895-906, vii.
- Boyd NF, Guo H, Martin LJ, Sun L, Stone J, Fishell E, et al. Mammographic density and the risk and detection of breast cancer. N Engl J Med. 2007;356:227-36.
- Harvey JA, Bovbjerg VE. Quantitative assessment of mammographic breast density: relationship with breast cancer risk. Radiology. 2004;230:29-41.
- Pisano ED, Gatsonis C, Hendrick E, Yaffe M, Baum JK, Acharyya S, et al. Diagnostic performance of digital versus film mammography for breast-cancer screening. N Engl J Med. 2005;353:1773-83.
- Kulkarni S, Freitas V, Muradali D. Digital Breast Tomosynthesis: Potential Benefits in Routine Clinical Practice. 2022;73:107-20.
- Conant EF, Barlow WE, Herschorn SD, Weaver DL, Beaber EF, Tosteson AN, et al. Association of digital breast tomosynthesis vs digital mammography with cancer detection and recall rates by age and breast density. JAMA oncology. 2019;5:635-42.
- Naeim RM, Marouf RA, Nasr MA, Abd El-Rahman ME. Comparing the diagnostic efficacy of digital breast tomosynthesis with full-field digital mammography using BI-RADS scoring. Egyptian Journal of Radiology and Nuclear Medicine. 2021;52:1-13.
- Singla D, Chaturvedi AK, Aggarwal A, Rao S, Hazarika D, Mahawar V. Comparing the diagnostic efficacy of full field digital mammography with digital breast tomosynthesis using BIRADS score in a tertiary cancer care hospital. Indian Journal of Radiology and Imaging. 2018;28:115-22.
- Skaane P, Bandos AI, Niklason LT, Sebuødegård S, Østerås BH, Gullien R, et al. Digital mammography versus digital mammography plus tomosynthesis in breast cancer screening: the Oslo Tomosynthesis Screening Trial. Radiology. 2019;291:23-30.
- Whelehan P, Ali K, Vinnicombe S, Ball G, Cox J, Farry P, et al. Digital breast tomosynthesis: sensitivity for cancer in younger symptomatic women. Br J Radiol. 2021;94:20201105.
- Mutar MT, Goyani MS, Had AM, Mahmood AS. Pattern of Presentation of Patients With Breast Cancer in Iraq in 2018: A Cross-Sectional Study. Journal of Global Oncology. 2019:1-6.
- Alwan NA, Tawfeeq FN, Mallah N. Demographic and clinical profiles of female patients diagnosed with breast cancer in Iraq. J Contemp Med Sci. 2019;5:14-19.
- Mjali A, Jawad SA, Al-Shammari HHJ. Breast cancer in middle euphrates region of Iraq: risk factors, presenting symptoms and time to medical help-seeking. Asian Pacific Journal of Cancer Care. 2021;6:243-47.
- Cathcart-Rake EJ, Ruddy KJ, Bleyer A, Johnson RH. Breast cancer in adolescent and young adult women under the age of 40 years. JCO oncology practice. 2021;17:305-13.
- Boyd NF, Martin LJ, Bronskill M, Yaffe MJ, Duric N, Minkin S. Breast tissue composition and susceptibility to breast cancer. Journal of the National Cancer Institute. 2010;102:1224-37.
- Ji Y, Li B, Zhao R, Zhang Y, Liu J, Lu H. The relationship between breast density, age, and mammographic lesion type among Chinese breast cancer patients from a large clinical dataset. BMC Medical Imaging. 2021;21:1-6.
- Chiu SY-H, Duffy S, Yen AM-F, Tabár L, Smith RA, Chen H-H. Effect of baseline breast density on breast cancer incidence, stage, mortality, and screening parameters: 25-year follow-up of a Swedish mammographic screening. Cancer Epidemiology and Prevention Biomarkers. 2010;19:1219-28.
- Phi X-A, Tagliafico A, Houssami N, Greuter MJ, de Bock GH. Digital breast tomosynthesis for breast cancer screening and diagnosis in women with dense breasts–a systematic review and meta-analysis. BMC cancer. 2018;18:1-9.
- Rafferty EA, Durand MA, Conant EF, Copit DS, Friedewald SM, Plecha DM, et al. Breast cancer screening using tomosynthesis and digital mammography in dense and nondense breasts. Jama. 2016;315:1784-86.
- Østerås BH, Martinsen ACT, Gullien R, Skaane P. Digital mammography versus breast tomosynthesis: impact of breast density on diagnostic performance in population-based screening. Radiology. 2019;293:60-68.
- Asbeutah AM, Karmani N, Asbeutah AA, Echreshzadeh YA, AlMajran AA, Al-Khalifah KH. Comparison of digital breast tomosynthesis and digital mammography for detection of breast cancer in Kuwaiti women. Medical Principles and Practice. 2019;28:10-15.
- Kulkarni S, Freitas V, Muradali D. Digital breast tomosynthesis: potential benefits in routine clinical practice. Canadian Association of Radiologists Journal. 2022;73:107-20.
|
