Shadi Aminololama-Shakeri MD, Presenter: Nothing to Disclose

Anita Nosratieh, Abstract Co-Author: Nothing to Disclose

Karen K. Lindfors MD, Abstract Co-Author: Research Grant, Hologic, Inc

John M. Boone PhD, Abstract Co-Author: Research Grant, Siemens AG Research Grant, Hologic, Inc Consultant, Varian Medical Systems, Inc

To compare the conspicuity of BIRADS 4 and 5 lesions on digital breast tomosynthesis (DBT), contrast enhanced breast CT (CEbCT) and digital mammography (DM).

105 patients with 103 BIRADS 4 or 5 lesions were prospectively enrolled in our IRB-approved study. Patients had DM & DBT (14), DM & CEbCT (45), or DM, DBT & CEbCT (44). All lesions were biopsied. Patients received 100 ml of IV iodixanol 320 at a rate of 3 ml/s for CEbCT. 2 experienced radiologists independently assigned a conspicuity score (CS) of 0-10 for each biopsied lesion (0=not seen, 10=excellent conspicuity). Results are shown as mean CS+/-SD. Significant differences among conspicuity of lesions on DM, DBT & CEbCT (p<0.05) were tested with one-way ANOVA and Dunn’s multiple comparison test for more than 2 groups (GraphPad Prism v5).

Of 103 breast lesions, 58 (56%) were malignant and 45 (44%) were benign. 27 (47%) of the malignant lesions were masses and 31 (53%) were calcifications. Of 45 benign lesions, 18 (40%) were masses and 27 (60%) were calcifications. Malignant masses were significantly more conspicuous on CEbCT than on DBT or DM (9.7+/-0.5 n=23 vs 7.0+/-2.9 n=13 and 6.9+/-2.7 n=27 respectively p<0.001). Malignant calcifications were equally conspicuous on all 3 modalities (CEbCT 8.7+/-0.9 n=16, DBT 8.5+/-0.6 n=15 DM 8.7+/-0.7 n=31; p=NS). Benign masses were equally conspicuous on CEbCT (8.2+/-2.9 n=15) & DBT (8.5+/-1.1 n=11) both of which were superior to DM (7.3+/-2.2 n=18). This trend did not reach statistical significance (p=0.06). Conspicuity of benign calcifications was equal on DBT (8.4+/-1.1 n=19) & DM (8.7+/-0.8 n=27) but significantly less on CEbCT (4.2+/-3.2 n=25 p<0.001). Of this cohort of patients (103), 44 underwent all 3 modalities prior to biopsy. Analysis of this subset followed the above results closely.

CEbCT and DBT are promising new techniques for detection of breast lesions. We show that CEbCT and DBT are similar to DM in detection of malignant calcifications and benign masses. But malignant masses are more conspicuous and benign calcifications are less conspicuous on CEbCT than DBT & DM. While these results favor CEbCT for detection of malignant masses in comparison to the other 2 modalities, the latter observation underscores the potential of decreasing false positive evaluations.

DBT and CEbCT are emerging technologies showing promise as complementary tools to DM.

Aminololama-Shakeri, S, Nosratieh, A, Lindfors, K, Boone, J, Is Contrast Enhanced Dedicated Breast Computed Tomography Superior to Digital Breast Tomosynthesis and Digital Mammography in the Evaluation of BI-RADS 4 and 5 Breast Lesions?.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13021176.html