Comparing the diagnostic efficacy of full field digital mammography with digital breast tomosynthesis using BIRADS score in a tertiary cancer care hospital

Abstract

Introduction:Breast cancer is one of the leading cancers in females worldwide, and its incidence has been rising at an exponential pace in the last 10 years even in India. Mammography has been the mainstay for detection of breast cancer over decades and has gradually advanced from screen film to full-field digital mammography. Recently, tomosynthesis has evolved as an advanced imaging investigation for early diagnosis of breast lesions in both diagnostic and screening settings.Aim of Study:To compare and evaluate the impact of digital breast tomosynthesis (DBT) compared to full-field digital mammography (FFDM) in the interpretation of BIRADS score in both diagnostic and screening settings.Settings and Design:A 1-year prospective longitudinal study was conducted in the Department of Radio-diagnosis in our institute using Hologic Selenia Dimensions for mammography as well as tomosynthesis.Materials and Methods:One hundred women known or suspected (opportunistic screening) for breast cancer were evaluated either with FFDM alone or both FFDM and DBT. Sensitivity, specificity, positive predictive value, negative predictive value, and P value were used to assess the various diagnostic criteria in our study.Results:Addition of DBT to FFDM results in a statistically significant increase in the sensitivity, specificity, and positive predictive value, and a statistically significant decrease in the false positive rates. Similar results were noted in both diagnostic and screening cases. It was observed that, in most cases, i.e. a total of 47, DBT did not change the BIRADS scoring; however, its addition increased the diagnostic confidence. BIRADS was upgraded and downgraded in 14 and 31 cases, respectively, with the addition of DBT to FFDM. New lesions were seen with addition of DBT to FFDM in 8 cases.Conclusion:Addition of DBT to FFDM results in increase in sensitivity, specificity, positive predictive value, and a statistically significant decrease in false positive rates in both diagnostic and screening cases. As addition of tomosynthesis results in a significant decrease in recall rate, it should be added, at least, in all screening mammography programs.

Comparing the diagnostic efficacy of digital breast tomosynthesis with full-field digital mammography using BI-RADS scoring

“…Our results were comparable to prior studies done by Conant et al [11], Skaane et al [12], and Divya et al [13] who reported increased sensitivity, specificity, and increased cancer detection when DBT was used. Skaane et al found increase sensitivity from 54.1 to 70.5% and mild increase in specificity from 94 to 95% by using DBT compared to digital mammography [12].…”

“…Our results were comparable to a study performed by Divya et al [13], which conducted a comparison between DBT and FFDM according to the BIRADS scoring. With the addition of tomosynthesis to FFDM 53% of the cases changing their BIRADS scoring, BIRADS was upgraded in 14% and downgraded in 31% of cases and DBT did not change the BIRADS scoring in 47% of cases but its addition increased the diagnostic confidence.…”

“…Skaane et al found increase sensitivity from 54.1 to 70.5% and mild increase in specificity from 94 to 95% by using DBT compared to digital mammography [12]. While Divya et al showed that sensitivity increased from 83.6 to 100%, also specificity increased from 38.7 to 87.77% and positive predictive value raised from of 56 to 81.67% after adding DBT to FFDM [13].…”

“…Divya et al [13] concluded that the most significant decrease in recall rates was due to a reduction in falsepositive patients. Combination of the two modalities leads to reduction in BIRADS in 31% of patients with a significant decrease in recall rates seen in ACR categories b, c, d, and age groups < 40 years due to improved sensitivity, specificity, positive predictive value, and reduced false-positive value.…”

Comparative study between digital breast tomosynthesis plus digital mammography and digital mammography alone in symptomatic women using BI-RADS score

“…Singla et al, 23 found that in most cases (47) DBT did not change BIRADS scoring but its addition increased the diagnostic confidence. Almost similar results were reported by our study where BIRADS was upgraded in only 3 cases and downgraded in only one case with the addition of DBT to FFDM.…”