Digital Breast Tomosynthesis in the Diagnostic Setting: Indications and Clinical Applications

Abstract

Digital breast tomosynthesis (DBT) is an emerging technology used in diagnostic breast imaging to evaluate potential abnormalities. In DBT, the compressed breast tissue is imaged in a quasi-three-dimensional manner by performing a series of low-dose radiographic exposures and using the resultant projection image dataset to reconstruct cross-sectional in-plane images in standard mammographic views. Improved visualization of breast detail at diagnostic DBT allows improved characterization of findings, including normal structures and breast cancer. This technology reduces the summation of overlapping breast tissue, which can mimic breast cancer, and provides improved detail of noncalcified mammographic findings seen in breast cancer. It also assists in lesion localization and determining mammographic extent of disease in women with known or suspected breast cancer. The authors review the potential uses, benefits, and limitations of DBT in the diagnostic setting and discuss how radiologists can best use DBT to characterize lesions, localize potential abnormalities, and evaluate the extent of known or suspected breast cancer. The authors' experience shows that DBT can be implemented effectively in the diagnostic workflow to evaluate and localize potential lesions more efficiently. DBT may potentially replace conventional supplemental mammography at diagnostic workup and obviate ultrasonography in select cases.

Tubular Carcinoma of the Breast: Advantages and Limitations of Breast Tomosynthesis

“…Also, DBT improved diagnosis confidence in a malignant lesion, showing a central mass with large spicules, which was not featured on mammography. This is in accordance with known advantages of DBT: improved conspicuity and characterization of lesions due to reduced obscuration by overlapping breast tissue [5, 6]. Described false negatives of DBT are mainly related to areas of dense tissue without fat planes that blur tumor margins, particularly in the smaller ones [4].…”

Whole-Body Clinical Applications of Digital Tomosynthesis

“…During this process, the single detector is stationary or moves in the parallel but opposite direction. In DBT with FPD mammography systems from various vendors including Siemens Healthcare (Mammomat Inspiration; Erlangen, Germany), Hologic (Selenia Dimensions; Bedford, Mass), and GE Healthcare (Senographe Essential; Little Chalfont, England), patient positioning and breast compression are similar to those of conventional mammography (3,4,20).…”

“…With most DBT imaging systems, craniocaudal and mediolateral oblique views can be acquired for both two-dimensional (2D) mammography and DBT imaging for each breast (21). Currently, there is debate over what 2D and three-dimensional (3D) views should be included as part of a standard DBT screening examination (2,3). There are many opinions and differences between what is being investigated by academic researchers, what is used in clinical practice, and the approved indications for use stated by the manufacturers.…”

“…Currently, the area receiving the most clinical and research interest in DT is mammographic imaging or so-called digital breast tomosynthesis (DBT). It is believed that DBT has the potential to reduce recall rates, improve selection of patients for biopsy, and increase cancer detection rates by reducing overlap of tissues, notably in patients with dense breasts (in particular, scattered and heterogeneous breast densities) (1)(2)(3)(4). Manufacturers, such as Hologic and GE Healthcare, offer upgrade paths for standard mammography systems to become breast tomosynthesis capable.…”

Invited Commentary on “Breast MR Imaging for Equivocal Mammographic Findings”

“…Most studies comparing two-dimensional digital mammography (2DDM) alone to 2DDM + DBT show an improvement in both sensitivity and specificity when DBT is added, particularly of noncalcified findings (6)(7)(8). It can also improve reader confidence to dismiss asymmetries that do not demonstrate 3D features (9). DBT has also proven useful in the problem-solving (diagnostic) setting by improving the visibility of lesions and revealing otherwise difficult-to-perceive features such as subtle radiating lines caused by architectural distortion and low-contrast margins of a mass.…”