Laurie Lee Fajardo MD, MBA, Presenter: Scientific Advisory Board, Hologic, Inc Member, Koninklijke Philips Electronics NV

Limin Yang MD, PhD, Abstract Co-Author: Nothing to Disclose

Jeong Mi Park MD, Abstract Co-Author: Nothing to Disclose

To assess imaging characteristics, histopathology results, cancer detection rate and biopsy PPV3 for lesions detected only by digital breast tomosynthesis (DBT) when used in combination with 2D digital mammography (DM) in a general population-screening group.

Beginning September 2012, we offered DBT in additioin to conventional DM to all women presenting for screening. To compare characteristics of lesions detected by DM with those detected additionally by DBT, we prospectively gathered information from biopsy recommendations for each, including: age, BI-RADS breast density rating, final BI-RADS assessment, lesion type and size, type of biopsy performed and histopathology outcomes. For all cancers diagnosed, the pathologic size, grade and lymph node status were ascertained.

For 4350 women undergoing screening from 9/2012 through 3/2013, 50 biopsy recommendations were made, including 15 biopsies in 2610 women choosing to undergo DBT as part of their screening exam. Lesions recommended for biopsy by DM included: 19 calcifications of which 2 were invasive cancer, 5 DCIS and 12 benign; 14 masses of which 6 were invasive cancer and 8 were benign; and 2 focal asymmetries - both benign. Characteristics of DBT detected lesions recommended for biopsy included: 6 masses of which 5 were invasive cancers and 1 benign; and 8 architectural distortions of which 6 were invasive cancers and 4 were benign. All DBT detected lesions were visible by and biopsied using ultrasound guidance. The biopsy PPVs for 2D digital mammography and DBT were 0.37 and 0.73, respectively. Pathologically, cancers detected only by DBT comprised 7 invasive ductal carcinomas, 3 invasive lobular carcinomas and 1 mixed ductal-invasive carcinoma. A majority of DBT detected cancers were small (pathologic size: 5 ≤ 10mm, 4 = 11-20mm, and 2 ≥ 20mm); low or intermediate pathologic stage (6 = Elston-Ellis grade 1; 4 = grade 2; 1 = grade 3); and lymph node negative (9/11).

Fifteen additional cancers (30% increase) were detected and PPVs improved by DBT when combined with DM in our screening population. Our early experience with suspicious lesions seen only by DBT indicates the majority are clinically significant and curable.

The addition of DBT to DM for screening improves cancer detection rate and biopsy PPV3 by detecting, additional small, early stage breast cancers beyond those detected by conventional DM.

Fajardo, L, Yang, L, Park, J, Imaging and Histopathology Findings of Breast Lesions Detected by Tomosynthesis.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13028023.html