Korean J Radiol.  2019 Jan;20(1):58-68. 10.3348/kjr.2018.0012.

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

• Lee SH
• Jang MJ
• Kim SM
• Yun BL
• Rim J
• Chang JM
• Kim B
• Choi HY

• KMID: 2429920
• DOI: http://doi.org/10.3348/kjr.2018.0012

Abstract

OBJECTIVE
To 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 METHODS
Three 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.
RESULTS
Forty 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).
CONCLUSION
Invasive 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.

Keyword

3D-mammography; DBT; FFDM; Breast neoplasm

MeSH Terms

Breast Neoplasms*
Breast*
Carcinoma, Intraductal, Noninfiltrating
Epidermal Growth Factor
Female
Humans
Mammography*
Retrospective Studies
Epidermal Growth Factor

Figure

• 

  Fig. 1 Flow chart of patient enrollment.DBT = digital breast tomosynthesis, FFDM = full-field digital mammography, MRI = magnetic resonance imaging

• 

  Fig. 2 56-year-old woman with ER/PR-negative, Her-2-positive, high-grade invasive ductal cancer in right breast.Conventional FFDM (A) and tomography (B) images of right breast in MLO view showing indistinct oval high-density mass with detectability score of 6 (arrows). Irregular rim-enhanced mass (arrow) was located in fat tissue and was 0 degree surrounded on MRI (C). ER = estrogen receptor, HER-2 = human epidermal growth factor receptor-2, MLO = mediolateral oblique, PR = progesterone receptor

• 

  Fig. 3 54-year-old woman with ER-positive, PR/Her-2-negative, low-grade invasive lobular cancer in left breast.Conventional FFDM of left breast in MLO view (A) showing asymmetry, with detectability score of 2 (arrows). Tomography of left breast in craniocaudal (B) and MLO (C) views showing architectural distortion, with detectability score of 6 (arrows). Regional heterogeneous non-mass enhancement (arrow) was located in fibroglandular tissue and was 7 (240 degrees) surrounded on MRI (D).

• 

  Fig. 4 51-year-old woman with triple negative, high-grade invasive ductal cancer in left breast.No abnormal findings (detectability score of 0) were noted on either conventional FFDM (A) or DBT (B) images. Mass (arrows) was located in fibroglandular tissue and was 10 (360 degree) surrounded on ultrasonography (C) and MRI (D).

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