Reni Simov Butler MD, Presenter: Nothing to Disclose

Reynolds Ostrover, Abstract Co-Author: Nothing to Disclose

Regina J. Hooley MD, Abstract Co-Author: Consultant, Guerbet

Jaime Lynn Geisel MD, Abstract Co-Author: Nothing to Disclose

Madhavi Raghu MD, Abstract Co-Author: Consultant, Hologic, Inc

Liane Elizabeth Philpotts MD, Abstract Co-Author: Consultant, Hologic, Inc.

To evaluate the effectiveness of digital breast tomosynthesis in the visualization of non-calcification breast cancers as a function of breast density

Upon IRB approval, all cancers diagnosed from 10/3/2011 through 1/16/2013 were reviewed. Of these, 186 cancers in 159 patients were imaged with tomosynthesis in combination with 2D mammography. Cancers presenting with calcifications as the only mammographic finding were excluded, leaving a total of 155 cases. Images were evaluated by 7 breast radiologists and classified into five categories: “Only Seen on Tomosynthesis”, “Better Seen on Tomosynthesis”, “Equally Well Seen on Both”, “Better Seen on 2D”, and “Only Seen on 2D”. The breast density, type of mammographic finding, clinical presentation, and cancer histology were recorded.

Patients with scattered and heterogeneously dense breasts had the highest percentage of cancers seen only with tomosynthesis, with 15.4%(10/65) and 14.0%(6/43), respectively, compared to only 5.9%(1/17) of patients with extremely dense breasts and 0%(0/30) of patients with fatty breasts. The scattered and heterogeneously dense breast categories also had the highest percentage of cancers seen better on tomosynthesis with 52.3%(34/65) and 55.8%(24/43), respectively, while the fatty breast category had the lowest percentage (13.3%,4/30). The extremely dense category had 35.3%(6/17) of cancers seen better with tomosynthesis. Finally, patients with fatty breasts and extremely dense breasts had the highest percentage of cancers seen equally well on tomosynthesis and 2D mammography, with 86.7%(26/30) and 58.8%(10/17), respectively, in contrast to 32.3%(21/65) and 30.2%(13/43), respectively, in the scattered and heterogeneously dense categories. 

Tomosynthesis imaging is particularly beneficial for visualizing non-calcification breast cancers in patients with scattered and heterogeneously dense breasts, with 67.7%(44/65) and 69.8%(30/43), respectively, of cancers in these categories seen only or better with tomosynthesis. Patients with fatty and extremely dense breasts are more likely to have cancers seen equally well on tomosynthesis and 2D mammography.

As tomosynthesis becomes more widely utilized, it is pertinent to understand its relative benefit in different groups of patients.

Butler, R, Ostrover, R, Hooley, R, Geisel, J, Raghu, M, Philpotts, L, Tomosynthesis in Breast Cancer Visualization as a Function of Mammographic Density.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13023015.html