Kelly Damico MD, Presenter: Nothing to Disclose

Ana P. Lourenco MD, Abstract Co-Author: Nothing to Disclose

Luke M. Partyka MD, Abstract Co-Author: Nothing to Disclose

Martha Beretta Mainiero MD, Abstract Co-Author: Nothing to Disclose

To determine the cancer yield of architectural distortion (AD) seen only or better on digital breast tomosynthesis (DBT) compared to digital mammography (DM) during routine screening.

An IRB approved, HIPAA compliant retrospective review of all screening DBT performed at an academic breast center from March 2012 through November 2013 identified all BIRADS 0 results. BI-RADS 0 reports were then reviewed to identify all cases of AD or possible AD. Cases were consensus reviewed by two fellowship trained breast radiologists and scored according to visibility of the AD (seen only on DM, better on DM, equally on DM and DBT, better on DBT, or only on DBT). All additional imaging and pathology results corresponding to the AD were reviewed, and results recorded in a database.

Of the 25,369 screening DBT exams, there were 1,769 (7%) BI-RADS 0 results. Of these, there were 84 (4.7%) reports of AD or possible AD. 32 were excluded, as AD or possible AD was not confirmed on consensus review. 52 cases of AD or possible AD detected at screening form the basis of this study. Of these, 26 (50%) were seen only on DBT, 23 (44%) seen better on DBT than DM, and 2 (4%) seen equally on DBT and DM. There were no cases seen only or better on DM. Of the 52 cases, 26 went on to biopsy (50%) with malignancy diagnosed in 54% (14/26) (biopsy positive predictive value). Biopsy also identified 7 radial scars and 5 benign findings. All 26 of the biopsied cases were either seen only on DBT or seen better on DBT. Of the malignancies, 57%(8/14) were DBT only findings. Surgical excision was required in 81% (21/26) of cases biopsied. Of the 26 cases that did not undergo biopsy, 8 (31%) were assessed as BI-RADS 3 and 13 (50%) as BI-RADS 1/2 on diagnostic evaluation. 1 case was lost to follow-up. 4 cases were assessed as BI-RADS 4/5 for lesions separate from the possible AD. Average follow-up for lesions not undergoing biopsy was 9.7 months. Overall cancer yield was 27% (14/52).

DBT detects areas of malignant AD not readily seen on DM. The 27% cancer yield in this study suggests that AD should not be dismissed even if detected only on DBT.

The cancer yield and biopsy positive predictive value of AD detected only on DBT is high. This finding should not be dismissed when identified at routine screening DBT.

Damico, K, Lourenco, A, Partyka, L, Mainiero, M, Cancer Yield of Architectural Distortion Detected on Screening Tomosynthesis.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14018838.html