Madhavi Raghu MD, Presenter: Consultant, Hologic, Inc

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

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

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

Melissa Angeline Durand MD, Abstract Co-Author: Nothing to Disclose

Liva Andrejeva-Wright MD, Abstract Co-Author: Nothing to Disclose

Laura Jean Horvath MD, Abstract Co-Author: Nothing to Disclose

Reni Simov Butler MD, Abstract Co-Author: Nothing to Disclose

To evaluate the rates of BI-RADS final assessment categories, in diagnostic patients undergoing tomosynthesis versus those undergoing 2D mammography with particular attention to BI-RAD3.

A retrospective review of all diagnostic patients over two six month intervals before (Jan-June 2011) and after (Aug 2012-Jan 2013) the implementation of tomosynthesis was performed. The percentage of mammograms categorized as BI-RADS 1-5 was determined. Particular attention was given to BI-RADS 3 and the reasons including asymmetries, calcifications, masses or architectural distortion were evaluated and compared between the two groups.

In the first interval,2850 diagnostic mammograms were performed.Of these patients,914 patients were categorized as BI-RADS 3(32%), 1670 patients as BI-RADS 1 or 2(59%), 179 patients as BI-RADS 4(6.3%) and 24 patients categorized as BI-RADS 5(0.8%).The 914 patients in the BI-RADS 3 category had 977 findings: asymmetries 363(37%), calcifications 398(40%), masses 201(21%) and architectural distortion 15(2%).In the second interval, 2761 diagnostic mammograms were performed, of which 2036 patients underwent tomosynthesis.Of these patients, 563 patients were categorized as BI-RADS 3(27.6%), 1315 patients as BI-RADS 1 or 2(64.6%), 153 patients as BI-RADS 4(5.8%) and 35 patients as BI-RADS 5(1.7%). The 563 BI-RADS 3 patients had 602 findings: asymmetries 186(31%), calcifications 245(41%), masses 158(26%) and architectural distortion 14(2%).The BI-RADS 3 rate decreased from 35% in the pre-tomo group to 27% in the post-tomo group (p<0.0005) with fewer asymmetries (p<0.0123) and masses (p<0.0133) requiring short term follow up.There was a concomitant increase in the number of patients categorized as BI-RADS 1 or 2 from 59% to 64.6% (p<0.0001). A larger percentage of lesions were also categorized as BI-RADS 5 (p=0.0076).

The use of tomosynthesis in diagnostic patients resulted in a significant decrease in the rate of BI-RADS 3, particularly for masses and asymmetries with a concomitant significant increase in the rate of BI-RADS 1/2 and 5.

Tomosynthesis use in diagnostic mammography can reduce the number of patients categorized as BI-RADS 3 requiring follow up.

Raghu, M, Hooley, R, Philpotts, L, Geisel, J, Durand, M, Andrejeva-Wright, L, Horvath, L, Butler, R, Digital Breast Tomosynthesis in Diagnostic Mammography: Can Tomo Affect the Final Assessment Categories?.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13026854.html