RSNA 2012 

Abstract Archives of the RSNA, 2012


Digital Breast Tomosynthesis in the Evaluation of Focal Mammographic Asymmetry, Do You Still Need Coned Compression Views?

Scientific Formal (Paper) Presentations

Presented on November 26, 2012
Presented as part of SSE02: Breast Imaging (Digital Breast Tomosynthesis)


Merit Mohamed ElMaadawy MD, Presenter: Nothing to Disclose
Jean M. Seely MD, Abstract Co-Author: Nothing to Disclose
Geoff Doherty MD, MSc, Abstract Co-Author: Nothing to Disclose
Shilpa Vidyadhar Lad MD, Abstract Co-Author: Nothing to Disclose


To compare the diagnostic performance of digital breast tomosynthesis (DBT) with that of coned compression (CC) views in the evaluation of a mammographic focal asymmetry.


Retrospectively 2 subspecialist breast imaging radiologists independently and blindly, evaluated the examinations of 50 patients with asymmetric mammographic density. In the first setting 25 CC and 25 DBT were evaluated for i) lesion visualization (disappeared, less conspicuous, persistent) II) favor benign or malignant nature if lesion persisted III) determine size and border shape of the lesion IV) degree of confidence in evaluating the focal asymmetry using each examination (four degree scale) V) need for US correlation. Following a 4 week delay in a 2nd setting the same observers evaluated the complement images of the first setting. The original FFDM images for each patient provided for comparison . The reference standard was a third experienced breast imager who had access to all imaging modalities as well as pathology,  imaging and clinical follow-up. The total time spent in evaluating the examinations using each modality was determined as well.


In patients with asymmetric mammographic density, DBT showed higher sensitivity (93.8%) for lesion visualization and differentiation of a true lesion from summation artifact as compared with sensitivity of CC views (50.2%). By Kappa statistics there was substantial agreement (K= 0.61) between the two readers using DBT; with only fair agreement (K= 0.35) using CC views. The perceived need to proceed to US was higher using CC views (75%) than DBT (53%). The radiologists’ confidence was greater with DBT than CC, with 95% at confidence level 3 or 4 with DBT, vs. 68% for CC (p < 0.0001).


In evaluating focal mammographic asymmetry, DBT had a better diagnostic performance than CC in terms of lesion visibility, nature and morphologic assessment. DBT also significantly increased the reader’s confidence with less need to proceed to US.


Study suggests that DBT is the modality of choice in evaluating a focal mammographic asymmetry instead of CC views.

Cite This Abstract

ElMaadawy, M, Seely, J, Doherty, G, Lad, S, Digital Breast Tomosynthesis in the Evaluation of Focal Mammographic Asymmetry, Do You Still Need Coned Compression Views?.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL.