Asif Iqbal MBBS, Presenter: Nothing to Disclose

Michael J. Michell MBBCh, Abstract Co-Author: Nothing to Disclose

Rema Wasan MBBCh, Abstract Co-Author: Nothing to Disclose

Abdel Douiri PhD, Abstract Co-Author: Nothing to Disclose

David Evans MBBS, Abstract Co-Author: Nothing to Disclose

Clare Peacock MBBS, Abstract Co-Author: Nothing to Disclose

Juliet Clare Morel MBChB, MRCP, Abstract Co-Author: Nothing to Disclose

In the diagnostic and assessment setting, imaging workup essentially involves full field digital mammography (FFDM) and ultrasound (US) examination. This study examines the impact of the addition of digital breast tomosynthesis (DBT) on the diagnostic accuracy of FFDM and US combined. 

The study included cancer patients from assessment and symptomatic clinics who underwent FFDM, DBT and US scans. The diagnostic work up was carried out by five specialist breast radiologists. Three examinations were viewed sequentially and probability of malignancy was recorded as (M3 = probably benign, M4 = suspicious, M5 = malignant). A retrospective analysis was carried out between two combined imaging modes comprising of [FFDM and US] and [DBT plus FFDM and US]. An overall imaging opinion was given by taking the highest M score. Statistical analysis using weighted Kappa coefficients was used to assess the agreement between the two combined imaging modes.

243 histology proven malignant lesions were assessed in 237 patients. The percentage of cases classified as indeterminate (M3) by [FFDM+US] were 13.5% (33) and by [DBT+FFDM +US] were 10.7% [26]. The corresponding figures for suspicious (M4) were 20.1% [49] and 18.1% [44] respectively. For malignant (M5); [FFDM+US] mode scored 66.2% [161] and [DBT+FFDM +US] combined mode assigned 71.2% [173]. Five of the indeterminate (M3) from [FFDM+US] were reclassified as suspicious (M4) on [DBT+FFDM +US]. Similarly, DBT upgraded two of 33 indeterminate (M3) and 10 of 49 suspicious (M4) on [FFDM+US] into malignant(M5). Kappa agreement for [FFDM+US] was substantial, (κ = 0.7690; p <0.0001). After the addition of DBT, the agreement was almost perfect, (κ = 0.9034; p <0.0001).

These results demonstrate improvement in diagnostic accuracy with additional information from combining DBT. Fewer lesions were classified as uncertain and suspicious and more lesions were classified as malignant. Therefore, combining DBT with FFDM and US is an efficient multimodality tool. 

Combined use of DBT with FFDM and US will improve the diagnostic accuracy of mammographic workup of breast lesions, therefore should be performed and interpretted in tandem.

Iqbal, A, Michell, M, Wasan, R, Douiri, A, Evans, D, Peacock, C, Morel, J, Diagnostic Workup of Malignant Lesions Using Digital Breast Tomosynthesis Combined with Full Field Digital Mammography and Ultrasound Examination.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045584.html