Richard Earnest Sharpe MD, MBA, Presenter: Nothing to Disclose

Shambhavi Venkataraman MD, Abstract Co-Author: Nothing to Disclose

Jordana Phillips MD, Abstract Co-Author: Nothing to Disclose

Vandana Mukesh Dialani MD, Abstract Co-Author: Nothing to Disclose

Valerie J. Fein-Zachary MD, Abstract Co-Author: Research Consultant, Siemens AG

Seema Prakash MD, Abstract Co-Author: Nothing to Disclose

Priscilla Jennings Slanetz MD, MPH, Abstract Co-Author: Nothing to Disclose

Tejas S. Mehta MD, MPH, Abstract Co-Author: Nothing to Disclose

3D Digital breast tomosynthesis (DBT) has been introduced into breast cancer screening programs. A subset of patients screened with DBT often subsequently undergo additional imaging workup. This study seeks to determine whether additional diagnostic mammographic (MG) evaluation is clinically helpful for abnormalities detected on screening DBT images.

DBT was introduced in our department for screening on 12/15/12. All screening MGs performed with DBT and interpreted as BI-RADS 0 from 12/15/2012 – 2/15/14 at our institution were included in this prospective study. When patients returned for diagnostic work- up (including MG and/or ultrasound), the interpreting radiologist prospectively indicated whether additional MG imaging of screen-detected abnormalities (mass, asymmetry, architectural distortion, and microcalcifications), provided clinically useful information beyond that available from 2D-DBT screening. The overall utility of the additional MG views, as well as utility by type of abnormality, was evaluated and differences were analyzed using a Chi squared test.

There were 5,342 screening DBT exams performed during the study period. 323 (6.0%) patients had a BI-RADS 0 designation with 351 total findings at screening mammography. Abnormalities included 183 masses (52.1%), 75 asymmetries (21.4%), 75 calcifications (21.4%), and 18 architectural distortion (5.1%). Additional MG views were helpful in the evaluation of 170/351 (48.4%) findings, including 45/183 (24.6%) masses, 46/74 (62.2%) asymmetries, 10/18 (55.6%) areas of architectural distortion, and 69/75 (92.0%) calcifications. Additional MG images evaluated calcifications significantly better than other lesions (masses, asymmetries, architecal distortion) seen on screening DBT (p<0.0001).

The utility of additional diagnostic MG evaluation varies with lesion type. Our study suggests additional diagnostic MG should be performed in evaluating microcalcifications but may not be necessary for evaluation of masses, asymmetries, and architectural distortion seen on screening DBT. If diagnostic MG could be avoided, there is potential to increase patient satisfaction, decrease patient radiation exposure, lower costs, and improve operational efficiency.

Not all patients recalled from screening mammography with DBT may benefit from additional mammographic diagnostic evaluation.

Sharpe, R, Venkataraman, S, Phillips, J, Dialani, V, Fein-Zachary, V, Prakash, S, Slanetz, P, Mehta, T, Abnormalities Seen on Screening 3D Digital Breast Tomosynthesis: Is Additional Diagnostic Mammography Always Necessary?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14009807.html