Comparative Evaluation of Palpable Breast Lumps by Digital Breast Tomosynthesis and MRI Breast with its Histopathological Correlation

Abstract

Breast cancer is the leading cause of mortality and morbidity in females worldwide. Combating this, needs early detection of malignancy and prompt management. Various modalities available are-digital mammography +/tomosynthesis (DBT), ultrasound with colour Doppler and elastography, dynamic contrast enhanced MRI (DCE-MRI) with MRI being considered as the best. This study was done to compare efficacy of digital breast tomosynthesis and MRI breast in evaluation of palpable breast masses and other suspicious breast findings. Material and methods: A prospective study of 50 patients was carried out in the Department of Radio-diagnosis, Government Medical College, Kota [Rajasthan]. Females (20-72 years) with clinically palpable breast lump/nipple erosion/ nipple retraction/nipple discharge / for screening purposes / BI-RADS 3,4,5 were included. Cases on chemotherapy/ radiotherapy /post operative cases/recent biopsy done from the lesion/painful breast lesions/any contraindication to MRI /pregnant females/ BIRADS 1,2,6 were excluded. DBT and MRI was performed in each patient and results were correlated with histopathology. Results: Well circumscribed margins was most commonly associated with benignity Spiculated margins and gross architectural distortion(seen on both DBT and MRI), fine pleomorphic/grouped/linear/segmental/amorphous calcifications (seen on DBT),rim enhancement of mass with kinetic curve III, clumped/linear/segmental/focal non mass like enhancement (coinciding with calcifications on DBT), adjacent invasion and metastasis were associated with malignancy. Conclusion:Differentiation between benign and malignant lesions by DBT had 77.2% specificity with DCE-MRI having 95.45% specificity.Difference was statistically significant (Chi-square = 29.429 with 1 degree of freedom; P <0.001S).

Comparative Study of Digital Breast Tomosynthesis (DBT) with and without Ultrasound versus Breast Magnetic Resonance Imaging (MRI) in Detecting Breast Lesion

“…The sensitivity of DBT and DBT + USG were equivalent, which was 88.89%, whereas it was 100% on MRI. Our finding was comparable to several studies which reported sensitivity of DBT ranging from 90–93% with sensitivity of MRI near 100% [ 9 , 10 , 11 ]. In a study done by Kamal et al, in which they assessed the ability of DBT and MRI in improving the sensitivity of digital mammography, they noted that DBT alone had equal sensitivity compared to MRI, which was 92% [ 9 ].…”

“…The PPV of all three modalities in our study were generally lower, which were 66.7% for DBT, 72.7% for DBT + USG and 64.3% for MRI, as compared to other literature review, i.e., 80.6–85.7% for DBT, 82.8% for DBT + USG and 71.1–96.6% for MRI [ 8 , 10 , 24 ]. This was likely due to the nature of lesion categorization in our study, i.e., BI-RADS 3 was categorized as malignant.…”

“…This was in accordance with a study done by Sudhir et al, whose study showed similar accuracy of 83.7% for DBT and 84.3% for DBT + USG; however, it was not statistically significant [ 24 ]. Saxena et al, on the other hand reported better accuracy for DBT and MRI, which were 90% and 98%, respectively [ 10 ]. This could be due to the differences in lesion categorization between these studies; in their study, BI-RADS 4 and 5 were regarded as malignant, whereas in our study BI-RADS 3, 4 and 5 were regarded as malignant.…”

“…These findings were in accordance with Saxena et al, who showed specificity of DBT alone was 77.2%. However, their specificity of MRI was higher, at 95.5%, and it showed statistical significance [ 10 ]. This could be because our study regarded BI-RADS 3 lesion as malignant.…”

“…Roganovic et al and Kamal et al, reported that DBT has a sensitivity of 92 to 93%, which is comparable to breast MRI (92 to 100%) [ 8 , 9 ]. Saxena et al, reported that MRI has better specificity compared to DBT [ 10 ]. However, Comstock et al, shows that DBT has sensitivity as low as 39% but with specificity as high as 97%, which both showed significant difference compared to MRI [ 11 ].…”