Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Digital Breast Tomosynthesis versus MRI as an Adjunct to Full-Field Digital Mammography for Preoperative Evaluation of Breast Cancer according to Mammographic Density

  • Haejung Kim (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • So Yeon Yang (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Joong Hyun Ahn (Biomedical Statistics Center, Samsung Medical Center) ;
  • Eun Young Ko (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Eun Sook Ko (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Boo-Kyung Han (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ji Soo Choi (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2021.04.16
  • Accepted : 2022.08.18
  • Published : 2022.11.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: To compare digital breast tomosynthesis (DBT) and MRI as an adjunct to full-field digital mammography (FFDM) for the preoperative evaluation of women with breast cancer based on mammographic density. Materials and Methods: This retrospective study enrolled 280 patients with breast cancer who had undergone FFDM, DBT, and MRI for preoperative local tumor staging. Three radiologists independently sought the index cancer and additional ipsilateral and contralateral breast cancers using either FFDM alone, DBT plus FFDM, or MRI plus FFDM. Diagnostic performances across the three radiologists were compared among the reading modes in all patients and subgroups with dense (n = 186) and non-dense breasts (n = 94) according to mammographic density. Results: Of 280 patients, 46 (16.4%) had 48 additional (39 ipsilateral and nine contralateral) cancers in addition to the index cancer. For index cancers, both DBT plus FFDM and MRI plus FFDM showed sensitivities of 100% in the non-dense group. In the dense group, DBT plus FFDM showed lower sensitivity than that of MRI plus FFDM (94.6% vs. 99.6%, p < 0.001). For additional ipsilateral cancers, DBT plus FFDM showed specificity and positive predictive value (PPV) of 100% in the non-dense group, but sensitivity and negative predictive value (NPV) were not statistically different from those of MRI plus FFDM (p > 0.05). In the dense group, DBT plus FFDM showed higher specificity (98.2% vs. 94.1%, p = 0.005) and PPV (83.1% vs. 65.4%; p = 0.036) than those of MRI plus FFDM, but lower sensitivity (59.9% vs. 75.3%; p = 0.049). For contralateral cancers, DBT plus FFDM showed higher specificity than that of MRI plus FFDM (99.0% vs. 96.7%, p = 0.014), however, the other values did not differ (all p > 0.05) in the dense group. Conclusion: DBT plus FFDM showed an overall higher specificity than that of MRI plus FFDM regardless of breast density, perhaps without substantial loss in sensitivity and NPV in the diagnosis of additional cancers. Thus, DBT may have the potential to be used as a preoperative breast cancer staging tool.

Keywords

References

  1. Skaane P, Gullien R, Bjorndal H, Eben EB, Ekseth U, Haakenaasen U, et al. Digital breast tomosynthesis (DBT): initial experience in a clinical setting. Acta Radiol 2012;53:524-529 
  2. Roth RG, Maidment AD, Weinstein SP, Roth SO, Conant EF. Digital breast tomosynthesis: lessons learned from early clinical implementation. Radiographics 2014;34:E89-E102 
  3. Zackrisson S, Lang K, Rosso A, Johnson K, Dustler M, Fornvik D, et al. One-view breast tomosynthesis versus two-view mammography in the Malmo Breast Tomosynthesis Screening Trial (MBTST): a prospective, population-based, diagnostic accuracy study. Lancet Oncol 2018;19:1493-1503 
  4. Hovda T, Holen AS, Lang K, Albertsen JL, Bjorndal H, Brandal SHB, et al. Interval and consecutive round breast cancer after digital breast tomosynthesis and synthetic 2D mammography versus standard 2D digital mammography in BreastScreen Norway. Radiology 2020;294:256-264 
  5. Hofvind S, Holen AS, Aase HS, Houssami N, Sebuodegard S, Moger TA, et al. Two-view digital breast tomosynthesis versus digital mammography in a population-based breast cancer screening programme (To-Be): a randomised, controlled trial. Lancet Oncol 2019;20:795-805 
  6. Bernardi D, Macaskill P, Pellegrini M, Valentini M, Fanto C, Ostillio L, et al. Breast cancer screening with tomosynthesis (3D mammography) with acquired or synthetic 2D mammography compared with 2D mammography alone (STORM-2): a population-based prospective study. Lancet Oncol 2016;17:1105-1113 
  7. Ciatto S, Houssami N, Bernardi D, Caumo F, Pellegrini M, Brunelli S, et al. Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study. Lancet Oncol 2013;14:583-589 
  8. Osteras BH, Martinsen ACT, Gullien R, Skaane P. Digital mammography versus breast tomosynthesis: impact of breast density on diagnostic performance in population-based screening. Radiology 2019;293:60-68 
  9. Conant EF, Zuckerman SP, McDonald ES, Weinstein SP, Korhonen KE, Birnbaum JA, et al. Five consecutive years of screening with digital breast tomosynthesis: outcomes by screening year and round. Radiology 2020;295:285-293 
  10. Bahl M, Mercaldo S, Dang PA, McCarthy AM, Lowry KP, Lehman CD. Breast cancer screening with digital breast tomosynthesis: are initial benefits sustained? Radiology 2020;295:529-539 
  11. Rafferty EA, Durand MA, Conant EF, Copit DS, Friedewald SM, Plecha DM, et al. Breast cancer screening using tomosynthesis and digital mammography in dense and nondense breasts. JAMA 2016;315:1784-1786 
  12. Caumo F, Zorzi M, Brunelli S, Romanucci G, Rella R, Cugola L, et al. Digital breast tomosynthesis with synthesized two-dimensional images versus full-field digital mammography for population screening: outcomes from the Verona screening program. Radiology 2018;287:37-46 
  13. Mann RM, Cho N, Moy L. Breast MRI: state of the art. Radiology 2019;292:520-536 
  14. Berg WA, Zhang Z, Lehrer D, Jong RA, Pisano ED, Barr RG, et al. Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA 2012;307:1394-1404 
  15. Berg WA, Gutierrez L, NessAiver MS, Carter WB, Bhargavan M, Lewis RS, et al. Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology 2004;233:830-849 
  16. Orel SG, Schnall MD. MR imaging of the breast for the detection, diagnosis, and staging of breast cancer. Radiology 2001;220:13-30 
  17. Fischer U, Kopka L, Grabbe E. Breast carcinoma: effect of preoperative contrast-enhanced MR imaging on the therapeutic approach. Radiology 1999;213:881-888 
  18. Sardanelli F, Boetes C, Borisch B, Decker T, Federico M, Gilbert FJ, et al. Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group. Eur J Cancer 2010;46:1296-1316 
  19. Mann RM, Kuhl CK, Kinkel K, Boetes C. Breast MRI: guidelines from the European Society of Breast Imaging. Eur Radiol 2008;18:1307-1318 
  20. Bernardi D, Belli P, Benelli E, Brancato B, Bucchi L, Calabrese M, et al. Digital breast tomosynthesis (DBT): recommendations from the italian college of breast radiologists (ICBR) by the italian society of medical radiology (SIRM) and the italian group for mammography screening (GISMa). Radiol Med 2017;122:723-730 
  21. Kim WH, Chang JM, Moon HG, Yi A, Koo HR, Gweon HM, et al. Comparison of the diagnostic performance of digital breast tomosynthesis and magnetic resonance imaging added to digital mammography in women with known breast cancers. Eur Radiol 2016;26:1556-1564 
  22. Fornvik D, Kataoka M, Iima M, Ohashi A, Kanao S, Toi M, et al. The role of breast tomosynthesis in a predominantly dense breast population at a tertiary breast centre: breast density assessment and diagnostic performance in comparison with MRI. Eur Radiol 2018;28:3194-3203 
  23. D'Orsi CJ, Sickles EA, Mendelson EB, Morris EA. ACR BI-RADS atlas: breast imaging reporting and data system. Reston, VA: American College of Radiology, 2013 
  24. Luparia A, Mariscotti G, Durando M, Ciatto S, Bosco D, Campanino PP, et al. Accuracy of tumour size assessment in the preoperative staging of breast cancer: comparison of digital mammography, tomosynthesis, ultrasound and MRI. Radiol Med 2013;118:1119-1136 
  25. Fornvik D, Zackrisson S, Ljungberg O, Svahn T, Timberg P, Tingberg A, et al. Breast tomosynthesis: accuracy of tumor measurement compared with digital mammography and ultrasonography. Acta Radiol 2010;51:240-247 
  26. Fontaine M, Tourasse C, Pages E, Laurent N, Laffargue G, Millet I, et al. Local tumor staging of breast cancer: digital mammography versus digital mammography plus tomosynthesis. Radiology 2019;291:594-603 
  27. Mariscotti G, Houssami N, Durando M, Bergamasco L, Campanino PP, Ruggieri C, et al. Accuracy of mammography, digital breast tomosynthesis, ultrasound and MR imaging in preoperative assessment of breast cancer. Anticancer Res 2014;34:1219-1225 
  28. Elmi A, Conant EF, Kozlov A, Young AJ, Long Q, Doot RK, et al. Preoperative breast MR imaging in newly diagnosed breast cancer: comparison of outcomes based on mammographic modality, breast density and breast parenchymal enhancement. Clin Imaging 2021;70:18-24 
  29. Chudgar AV, Conant EF, Weinstein SP, Keller BM, Synnestvedt M, Yamartino P, et al. Assessment of disease extent on contrast-enhanced MRI in breast cancer detected at digital breast tomosynthesis versus digital mammography alone. Clin Radiol 2017;72:573-579 
  30. Mann RM, Balleyguier C, Baltzer PA, Bick U, Colin C, Cornford E, et al. Breast MRI: EUSOBI recommendations for women's information. Eur Radiol 2015;25:3669-3678 
  31. Selvi V, Nori J, Meattini I, Francolini G, Morelli N, De Benedetto D, et al. Role of magnetic resonance imaging in the preoperative staging and work-up of patients affected by invasive lobular carcinoma or invasive ductolobular carcinoma. Biomed Res Int 2018;2018:1569060 
  32. Parvaiz MA, Yang P, Razia E, Mascarenhas M, Deacon C, Matey P, et al. Breast MRI in invasive lobular carcinoma: a useful investigation in surgical planning? Breast J 2016;22:143-150