Jaime Lynn Geisel MD, Presenter: Consultant, Siemens AG

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

Madhavi Raghu MD, Abstract Co-Author: Nothing to Disclose

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

Paul H. Levesque MD, Abstract Co-Author: Nothing to Disclose

Liane Elizabeth Philpotts MD, Abstract Co-Author: Nothing to Disclose

Tomosynthesis (tomo) has been shown to reduce recalls from screening mammography and be equivalent or superior to conventional (2D) spot views. The value of spot tomo views has not yet been assessed. The purpose of our study is to determine in what lesions is additional diagnostic mammographic imaging beneficial.

A retrospective review of the breast imaging database was performed to identify all BIRADS 0 cases in patients undergoing tomosynthesis screening in a 6 month period, July 1, 2013 to December 31, 2013. Of 295 BIRADS 0 lesions, 157 lesions in 138 patients who had tomo spot views and US as part of the diagnostic work-up were included. Cases were retrospectively blindly reviewed on a dedicated workstation by 4 readers. Two readers evaluated each lesion for a total of 314 lesion assessments. Readers evaluated the screening tomosynthesis exam, followed by the US images and finally the additional diagnostic spot tomo views. The type of lesion (asymmetry, mass, architectural distortion), breast density, forced BIRADS and likelihood of malignancy were assessed at each stage. The outcome of cases in terms of final BIRADS assessment and biopsy results, when appropriate, was assessed.

The mammographic findings consisted of 182 asymmetries, 83 masses, and 49 architectural distortions. In 226 (72%), additional spot tomo views were assessed as not helpful to screening tomosynthesis. Spot views were reported helpful in assessing 57%(28/49) architectural distortions, 25%(45/182) asymmetries and 18%(15/83) masses. Spot views were considered more helpful in assessing lesions noted on one view only (41%), the majority of which were asymmetries (75%) and architectural distortions (20%), compared with two views (17%). Readers identified all 9 cancers with tomo and US. No additional cancers were detected with spot tomo views.

Spot tomosynthesis views did not add to the diagnostic evaluation in the majority of non-calcification cases recalled from tomosynthesis screening but were useful in many cases of questioned architectural distortion. The overall sensitivity of screening tomo and US alone was equivalent to that with spot images.

Routine screening tomosynthesis views allow adequate assessment of most mammographic findings such that US alone is required in the work up of the majority of cases recalled from screening which can save costs, radiation, exposure and time.

Geisel, J, Andrejeva-Wright, L, Raghu, M, Durand, M, Levesque, P, Philpotts, L, Screening Recalls after Tomosynthesis Mammography: Are Additional Mammographic Views Necessary?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14011801.html