Factors Affecting Breast Cancer Detectability on Digital Breast Tomosynthesis and Two-Dimensional Digital Mammography in Patients with Dense Breasts

Abstract

ObjectiveTo compare digital breast tomosynthesis (DBT) and conventional full-field digital mammography (FFDM) in the detectability of breast cancers in patients with dense breast tissue, and to determine the influencing factors in the detection of breast cancers using the two techniques.Materials and MethodsThree blinded radiologists independently graded cancer detectability of 300 breast cancers (288 women with dense breasts) on DBT and conventional FFDM images, retrospectively. Hormone status, histologic grade, T stage, and breast cancer subtype were recorded to identify factors affecting cancer detectability. The Wilcoxon signed-rank test was used to compare cancer detectability by DBT and conventional FFDM. Fisher's exact tests were used to determine differences in cancer characteristics between detectability groups. Kruskal-Wallis tests were used to determine whether the detectability score differed according to cancer characteristics.ResultsForty breast cancers (13.3%) were detectable only with DBT; 191 (63.7%) breast cancers were detected with both FFDM and DBT, and 69 (23%) were not detected with either. Cancer detectability scores were significantly higher for DBT than for conventional FFDM (median score, 6; range, 0–6; p < 0.001). The DBT-only cancer group had more invasive lobular-type breast cancers (22.5%) than the other two groups (i.e., cancer detected on both types of image [both-detected group], 5.2%; cancer not detected on either type of image [both-non-detected group], 7.3%), and less detectability of ductal carcinoma in situ (5% vs. 16.8% [both-detected group] vs. 27.5% [both-non-detected group]). Low-grade cancers were more often detected in the DBT-only group than in the both-detected group (22.5% vs. 10%, p = 0.026). Human epidermal growth factor receptor-2 (HER-2)-negative cancers were more often detected in the DBT-only group than in the both-detected group (92.3% vs. 70.5%, p = 0.004). Cancers surrounded by mostly glandular tissue were detected less often in the DBT only group than in the both-non-detected group (10% vs. 31.9%, p = 0.016). DBT cancer detectability scores were significantly associated with cancer type (p = 0.012), histologic grade (p = 0.013), T and N stage (p = 0.001, p = 0.024), proportion of glandular tissue surrounding lesions (p = 0.013), and lesion type (p < 0.001).ConclusionInvasive lobular, low-grade, or HER-2-negative cancer is more detectable with DBT than with conventional FFDM in patients with dense breasts, but cancers surrounded by mostly glandular tissue might be missed with both techniques.

Multifocality and Multicentrality in Breast Cancer: Comparison of the Efficiency of Mammography, Contrast-Enhanced Spectral Mammography, and Magnetic Resonance Imaging in a Group of Patients with Primarily Operable Breast Cancer

“…The sensitivity of digital mammography in detecting multiple breast lesions depends on breast structure. The greater the content of glandular tissue is, the lower the sensitivity of mammography is [38]. However, today, it is unfortunate to state that young women have glandular breasts and elderly women have fatty breasts.…”

Average glandular dose in paired digital mammography and digital breast tomosynthesis acquisitions in a population based screening program: effects of measuring breast density, air kerma and beam quality

“…This has been seen in a comparison of anatomical noise of structures of size greater than 2 mm in DM, DBT and dedicated breast CT. DM and DBT were shown to have similar anatomical noise, while CT images showed a reduction due to true 3D reconstruction (253). As DBT fundamentally relies on the same image contrast as DM, DBT must have peritumoral fat in order to visualize the tumor (254,255). Therefore, DBT improved cancer detection compared to DM similarly for all breast densities, including non-dense breasts, by finding smaller spiculated tumors or distortions.…”

Comparative analysis of cone‐beam breast computed tomography and digital breast tomosynthesis for breast cancer diagnosis: A comprehensive study on reconstruction algorithms

“…The incidence of female BC has gradually increased by approximately 0.5% annually since the mid‐2000s, primarily driven by localized‐stage and hormone receptor‐positive disease diagnoses 4 . Millions of women undergo digital mammography (DM) annually for early BC detection, 5 which is crucial for reducing mortality across all age groups 6 . Despite DM's effectiveness, concerns arise due to low sensitivity and specificity, particularly in dense breasts 7 .…”