Masses in the era of screening tomosynthesis: Is diagnostic ultrasound sufficient?

Abstract

In the era of digital breast tomosynthesis (DBT), the need for diagnostic mammography (MG) before a diagnostic ultrasound for masses recalled from screening tomosynthesis has been questioned. 1-3 Historically, most masses recalled from two-dimensional (2D) screening mammography underwent diagnostic mammography prior to ultrasound. 4,5 In this setting, diagnostic mammography views have been shown to increase the specificity of mammography by improving margin assessment, determining lesion location, and confirming persistence of the screen-detected mass. 5,6 In comparison to 2D imaging, DBT allows better differentiation of true findings from superimposition of fibroglandular tissue, increases mass margin visibility, and improves location assessment. 7-9 In addition, studies have shown that DBT has similar accuracy as routine diagnostic mammography for non-calcified findings, 10 is comparable to spot compression mammography for characterizing masses as benign or malignant, 1 and is equivalent or better than spot compression mammography for evaluating findings recalled from 2D screening mammography. 2,3,11 Currently, institutions and practitioners vary in how the work-up of masses recalled from screening tomosynthesis is performed, with some opting for ultrasound first and others performing diagnostic mammography before ultrasound. There are no clear American College of Radiology practice guidelines for work-up of DBT-detected masses. The purpose of this study is to compare outcomes of masses recalled from screening DBT worked-up initially with diagnostic mammography with those first evaluated with diagnostic ultrasound. MethodS and MaterIalS Study subjects, imaging technique, and interpretation Our Institutional Review Board approved this retrospective Health Insurance Portability and Accountability Act-compliant study. Informed consent was waived. We performed a retrospective review of our mammography reporting system for all screen-detected masses from July 1, 2017, from the time of our conversion to

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“…It is the perfect imaging tool for biopsy, as it distinguishes cystic masses from solid masses. Choudhery et al [70] investigated the adequacy of the US to detect masses. According to their study, most masses recalled from DBT screening can be evaluated with just an US.…”

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“…DBT can also detect subtle suspicious findings such as an irregular shape, and indistinct or spiculated margins. 18 19 20 …”

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“…US has advantages such as portability, lower cost than MG, the perfect imaging tool for biopsy, and versatility, as it distinguishes cystic masses from solid masses. Choudhery et al [67] investigated the adequacy of the US to detect masses. According to their study, most masses recalled from DBT screening can be evaluated with just a US.…”