Diagnostic performance of digital breast tomosynthesis with a wide scan angle compared to full-field digital mammography for the detection and characterization of microcalcifications
Introduction
Digital breast tomosynthesis (DBT) is an increasingly used technique in breast cancer screening and assessment [1], [2], [3]. DBT is able to overcome several limitations of mammography, in particular, tissue superimposition due to the acquisition of multiple x-ray projections and the reconstruction of pseudo-tomographic images. Various commercial systems are available at the present time, with different acquisition and reconstruction parameters [4].
Regardless of technical parameters, the added value of DBT in the evaluation of masses, asymmetries, and architectural distortions has been confirmed [5]. However, this does not apply to the assessment of microcalcifications [6]. Microcalcifications are a common finding in the breast that can be caused by benign changes or may represent an early sign of malignant disease [7]. A careful characterization of their morphology and distribution is essential to stratify the risk of malignancy and guide clinical management decisions, such as the need for further diagnostic work-up or standard follow-up [8]. Only a few studies have assessed the value of DBT in the detection and characterization of microcalcifications [9], [10], [11], [12]. Kopans et al. [9] reported a very good visibility and good image quality for microcalcifications in a side-by-side evaluation of mammography and DBT. Spangler et al. [10] concluded that digital mammography maintains a higher sensitivity and specificity for microcalcifications, compared to DBT. Tagliafico et al. [12] showed that DBT can miss malignant clusters of microcalcifications that can be easily detected with mammography. These preliminary results opened the discussion about whether DBT is suitable for the study of microcalcifications, a relevant issue that must be considered if DBT is to be used as a primary screening modality [6], [12].
It should be noted that the majority of studies that analysed microcalcifications used acquisition parameters characterized by relatively narrow scan angles, and always evaluated DBT in association with 2D imaging [10], [12], while data about the evaluation of microcalcifications using DBT with a wide scan-angle alone is still scarce. The scan-angle is the total angular range covered by the projections acquired during the examination. Scan-angle is one of the main acquisition parameters that affect the image quality of DBT, along with the number of projections and their distribution [13], [14]. Scan-angle is highly variable in different devices, ranging from 15° (narrow angle) to 50° (wide angle). The optimal combination of the different acquisition parameters is still a topic of intense discussion [13].
The aim of this study was to assess the performance of DBT with a wide scan-angle for the detection and characterization of microcalcifications, and to compare it with full-field digital mammography (FFDM). Inter-reader variability was taken into consideration. Reading time was also measured.
Section snippets
Patient selection
Eligible subjects for this IRB-approved, retrospective study were patients who had undergone digital breast tomosynthesis (DBT) as a screening or diagnostic examination at our institution between January 2010 and August 2012. Overall, 761 patients were examined.
Inclusion criteria used to generate our study cohort were: (a) availability of images from at least one breast with two views in FFDM and DBT examinations; (b) histopathological verification of microcalcifications; and (c) at least two
Detection rate and visibility
The detection rate for microcalcifications with FFDM and DBT is shown in Table 2.
Differences between detection rates were found for readers (P = 0.001) but not for modalities (P = 0.510). Also when benign and malignant microcalcifications were considered separately (Table 2) there was a significant inter-reader difference in the percentage of detection rates (P = 0.003), but there was no significant difference between the modalities (P > 0.496).
In two cases, microcalcifications were not detected with
Discussion
Our single-centre experience shows that DBT with a wide scan-angle alone performs as well as FFDM for the detection and characterization of the microcalcifications usually encountered in the clinical setting. The variability in the assessment of microcalcifications is influenced by the reader but not by the modality under evaluation.
The appropriate detection and characterization of microcalcifications plays a central role in the diagnosis of breast lesions. Preliminary results, obtained from
Conclusions
In conclusion, DBT with a wide scan-angle enables the detection and characterization of microcalcifications at a level comparable to that of FFDM. Therefore, DBT alone can be considered appropriate for the evaluation of microcalcifications. Detection and characterization were not influenced by the modality used, while, for both modalities, there was a significant inter-reader variability.
Conflicts of interest
No conflicts of interest.
Acknowledgments
The study was supported by a grant from Siemens Healthcare, (Erlangen, Germany) and Novomed, (Vienna, Austria) and a seeding grant from the “Privatstiftung für Brustgesundheit” (Vienna, Austria). We would like to thank Mary McAllister for the language revision of this text.
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Both authors equally contributed to the paper.