Pragya Ahuja Dang MD, Presenter: Nothing to Disclose

Kathryn Lynn Humphrey MD, Abstract Co-Author: Nothing to Disclose

Phoebe E. Freer MD, Abstract Co-Author: Nothing to Disclose

Elkan F. Halpern PhD, Abstract Co-Author: Research Consultant, Hologic, Inc

Mansi Awasthi Saksena MD, Abstract Co-Author: Nothing to Disclose

Elizabeth Ann Rafferty MD, Abstract Co-Author: Research Grant, Hologic, Inc

To compare tomosynthesis to conventional mammography for detection and characterization of biopsy proven invasive cancers.

In this IRB approved, HIPAA compliant study, 172 biopsy proven invasive breast cancers (142 Invasive ductal carcinoma-IDC, 25 Invasive lobular carcinoma-ILC, and 5 invasive mammary carcinoma; age range: 35-91 years), consecutively accrued prior to biopsy between 3/2011 and 10/2012 and imaged with combined tomosynthesis-mammography were retrospectively reviewed. The visibility (rated on 5-point scale) and morphology (shape and margins) of each cancer on 2 view tomosynthesis and 2 view mammography images were recorded.

The visibility scores for IDC with tomosynthesis and mammography were 3.4+/-1.1 and 2.6+/-1.2, respectively, and for ILC were 3.2 +/- 0.9 and 2.3 +/- 1.2, respectively; significantly higher for tomosynthesis compared to conventional mammography (p< 0.0001) for all cancers. 16% (28/172) cancers (20% ILC and 16% IDC) were occult on mammography, whereas 3% (5/172) cancers were occult on tomosynthesis. Common presentations of cancers on tomosynthesis were irregular spiculated masses (61%, 105/172), architectural distortion (12%, 20/172), and lobulated circumscribed masses (8%, 13/172). Of the cancers presenting as architectural distortion on tomosynthesis, 50% (10/20) were occult on conventional mammography and 20% (4/20) were characterized as asymmetry or focal asymmetry on conventional mammography. Cancers presenting as architectural distortion on tomosynthesis had a disproportionately higher percentage of ILCs (20%). Of the irregular spiculated masses on tomosynthesis, 10% (11/105) were occult, 33% (35/105) characterized as asymmetries or focal asymmetries, and only 32% (34/105) definitively characterized as irregular spiculated masses on conventional mammograms. No invasive cancers were characterized as round or oval circumscribed masses on tomosynthesis. Of the cancers occult on tomosynthesis, 1(20%) was visible as an asymmetry on mammography.

Tomosynthesis was significantly better than conventional mammography on detecting cancers particularly those presenting as architectural distortion as well as characterizing cancer morphology.

Identification of mammographically occult cancers and more accurate depiction of tumor morphology with tomosynthesis may allow formulation of a better assessment of the lesion on initial imaging.

Dang, P, Humphrey, K, Freer, P, Halpern, E, Saksena, M, Rafferty, E, Comparison of Lesion Detection and Characterization in Invasive Cancers Using Breast Tomosynthesis versus Conventional Mammography.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13016918.html