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Tomosynthesis vs digital mammography efficacy comparison using birads.pptx

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Nagasai Pelala

Digital breast tomosynthesis (DBT) improved detection and characterization of breast lesions compared to full-field digital mammography (FFDM) according to a prospective study. DBT identified lesions in 81.1% of patients versus 53.3% for FFDM. DBT upgraded BI-RADS scores for 52 patients and improved diagnostic accuracy from 71.11% for FFDM to 97.7% for DBT. The study concludes DBT is a promising technique that increases sensitivity and specificity, especially for young patients and those with dense breasts.

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Comparing the diagnostic efficacy of digital breast tomosynthesis with full-field digital mammography using BI-RADS scoring Presenter: Dr.Vishal Moderator :Dr.P Anjani
Aim of the work Our study aims to evaluate the impact of digital breast tomosynthesis (DBT) in comparison to full-field digital mammography in improving the detection and characterization of different breast lesions and interpretations of BIRADS scoring in all breast densities at different age groups.
Methods The study was a prospective study carried over 8 months with an extra 18 months when follow-up was needed in some cases. The study included 90 female patients with their ages ranged from 32 to 70 years (mean age 47.18 賊 11.24 SD). Full-field digital mammography and digital breast tomosynthesis were followed by US examination done for all patients.
Background Breast cancer incidence had increased by 20% with a possible increase of diagnosis before the age of 50. Cancer care had been individualized for patients, and thus, better characterization was required for treatment planning. Imaging examination is an important tool to help diagnose and decide therapeutic response.
Screening mammography is considered the primary technique, and the most important screening tool in breast cancer detection and assessment. It was responsible for a reduction in mortality among the age group of 40 years or older. Initially, screen-film mammography was done, but today, the most common two-view examination (mediolateral oblique and craniocaudal) using full-field digital mammography (FFDM) used, searching for any mass, architectural distortion, or calcification, and then giving BIRADS score.
Nevertheless, mammography suffers from several limitations due to the low contrast between tumors and surrounding tissue. Especially in dense breasts, this can lead to a decrease in sensitivity, and added imaging methods are necessary . Advances in full-field digital mammography (FFDM) led to the development of digital breast tomosynthesis, which is a three-dimensional breast examination.
The multi-view information from the multiple low-dose images used to generate thin slices (at 1-mm spacing) that viewed sequentially as a stack in orientation, e.g., craniocaudal, mediolateral oblique with the potential to improve accuracy by improving differentiation between malignant and non-malignant lesions
The primary operational advantage of tomosynthesis is that the procedure is very similar to the conventional mammography examination in the technologists tasks and the woman being imaged, yet it eliminates the limitation of full-field digital mammography by overlapping breast tissue. Therefore, tomosynthesis is implied easily in the current clinical practices with minor operational adjustments
Inclusion criteria Patients included in this study those referred from breast clinic for either: Screening purposes: whether primary screening or those who had already undergone treatment for breast cancer and were on yearly follow-up. Diagnostic purposes: women presenting with a palpable lump, or any other breast complaints such as nipple discharge or breast pain.
Exclusion criteria: Pregnant and lactating women Those having open breast wounds
FULL-FIELD DIGITAL MAMMOGRAPHY The technique of full-field digital mammography: During acquisition, the breast was compressed between breastplates and standard views medio lateral-oblique and craniocaudal views were taken for all patients.
The technique of 3D tomosynthesis During acquisition, the breast was compressed between breastplates as in conventional mammography, and the X-ray tube pivoted in an arc that varies between 15属 (narrow range) and 60属 (wide range) in a plane aligned with the chest wall allowing for 11 to 15 low-dose projection images (2D) acquired for the tomosynthesis images.
Images of the tomosynthesis were obtained in the same standard projections (craniocaudal and mediolateral oblique) as conventional screening mammography. Data from the low-dose projection 2D images used to reconstruct 1-mm-thick sections separated by 1-mm space to form the 3D volume of the compressed breast in the form of a series of images through the entire breast.
Image analysis and interpretation Two experienced readers independently viewed and interpreted FFDM, synthetic 2D, and DBT. Each breast was evaluated about the presence of lesions or not, site of the lesions, type (mass, architectural distortion, focal asymmetry), margin definition, and 賊 calcifications. Finally, the BIRADS category of the lesions in the imaging modalities individually determined according to the BIRADS lexicon 2013 classification (Table 1), and all cases were also categorized by breast density (according to ACR guidelines edition 2013) and age group. The obtained data were correlated with ultrasound examination.
The final diagnosis was obtained by histopathological assessment for lesions with BIRADS IV or more and those having BIRADS III further correlated with the ultrasound data, and then followed up (3 follow-up studies every 6 months). True positive and true negative were decided by further diagnostic work-up, which included other imaging studies by ultrasonography, histopathological examination, or follow-up.
Tomosynthesis vs digital mammography efficacy comparison using birads.pptx
Results In the current study, patients were divided into four groups according to breast density and according to the age group.
Tomosynthesis vs digital mammography efficacy comparison using birads.pptx
Tomosynthesis vs digital mammography efficacy comparison using birads.pptx
The distribution of different breast densities among different age groups is shown Out of the total 90 cases, 50 were diagnostic and 40 were screening cases.
Tomosynthesis vs digital mammography efficacy comparison using birads.pptx
As regard lesion detection, classification, and BIRADS category for each case, FFDM detected lesions in 48/90 cases (53.3%) from which 39/48 cases were classified as with malignant lesions (30/48 cases were given BIRADS score IV, 4/48 cases were given BIRADS score V and 5/48 cases were given BIRADS score VI). On the other hand, 9/48 cases were classified as benign lesions (2/48 cases were given BIRADS score II, 7/48 cases were given BIRADS score III) and considered 42/90 cases as negative (BIRADS I).
While DBT detected lesions in 73/90 cases (81.1%) from which classified 46/73 cases as with malignant lesions (25/73 cases were given BIRADS score IV, 16/73 cases were given BIRADS score V, 5/73 cases were given BIRADS score VI), whereas 27/73 cases were considered as with benign lesions (4/73 cases were given BIRADS score II, 23/73 patients were given BIRADS score III) and 17/90 cases as negative (BIRADS score I).
Tomosynthesis vs digital mammography efficacy comparison using birads.pptx
With correlation with the final diagnosis 17 cases were true negative and 73 cases were true positive for the presence of breast lesions from which 45 cases were malignant with invasive duct carcinomas detected in 44/ 45(97.7%) and DCIS associated IDC in 1/45 (2.2%) with 28 cases were benign breast lesions ( cysts, fibroadenoma, duct ectasia, and intramammary LNs).
By adding DBT to FFDM 52/90 cases were changed their BIRADS scoring as follows: 13 cases were upgraded from BIRADS I to IV, 14 cases were upgraded from BIRADS I to III, 12 cases were upgraded from BIRADS IV to V, and 4 cases were upgraded from BIRADS III to IV. Downgrading BIRADS scoring detected in 7 cases from IV to II and III and two cases were downgraded from BIRADS IV to I. In 38 cases, DBT did not change the BIRADS scoring, but its addition increased the diagnostic confidence and better evaluation of the lesions detected.
After revising the results of FFDM with the final diagnosis by other modalities, histopathology, and/or close follow-up, 29 cases were true positive, 10 cases were false positive, 16 cases were false negative, and 35 cases were true negative. Diagnostic indices of mammography were a sensitivity of 64.44%, a specificity of 77.78%, a positive predictive value of 74.63%, a negative predictive value of 68.63%, and a diagnostic accuracy of 71.11%. While for DBT 45 cases were true positive, 1 case was false positive, no cases were false negative, and 44 cases were true negative. Diagnostic indices were a sensitivity of 100%, a specificity of 97.77%, a positive predictive value of 97.78%, anegative predictive value of 100%, and a diagnostic accuracy of 97.7%.
Tomosynthesis vs digital mammography efficacy comparison using birads.pptx
Tomosynthesis vs digital mammography efficacy comparison using birads.pptx
Tomosynthesis vs digital mammography efficacy comparison using birads.pptx
Tomosynthesis vs digital mammography efficacy comparison using birads.pptx
Tomosynthesis vs digital mammography efficacy comparison using birads.pptx
Tomosynthesis vs digital mammography efficacy comparison using birads.pptx
Tomosynthesis vs digital mammography efficacy comparison using birads.pptx
Tomosynthesis vs digital mammography efficacy comparison using birads.pptx
Discussion Mammogram has been the gold standard technique and the mainstay for the detection of breast cancer over decades. Women with the dense breasts meet two major problems, as increased breast density decreases the sensitivity and specificity of mammography owing to a decrease in the contrast between tumor and surrounding breast tissue, and superimposed breast tissues may obscure lesions, resulting in a considerable number of false- negative mammograms.
The dense breast itself is a risk factor for developing breast cancer. Tomosynthesis has evolved as advanced imaging technique for early diagnosis of breast lesions with a promising role particularly in dense and treated breasts . Digital breast tomosynthesis provides 3D imaging of the breast, so it reduces the superimposition of breast tissue and improves cancer detection. Previous studies showed that DBT improved the sensitivity, specificity, and accuracy of full-field digital mammography by reducing the recall rate and increasing the cancer detection rate
Conclusion DBT is a promising imaging modality offering better detection and characterization of different breast abnormalities, especially in young females, and those with dense breasts with an increase of sensitivity and specificity than FFDM. This leads to a reduction in the recalled cases, negative biopsies, and assessing the efficacy of therapy as it enables improving detection of breast cancer and different breast lesions not visualized by conventional mammography.
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Tomosynthesis vs digital mammography efficacy comparison using birads.pptx

  • 1. Comparing the diagnostic efficacy of digital breast tomosynthesis with full-field digital mammography using BI-RADS scoring Presenter: Dr.Vishal Moderator :Dr.P Anjani
  • 2. Aim of the work Our study aims to evaluate the impact of digital breast tomosynthesis (DBT) in comparison to full-field digital mammography in improving the detection and characterization of different breast lesions and interpretations of BIRADS scoring in all breast densities at different age groups.
  • 3. Methods The study was a prospective study carried over 8 months with an extra 18 months when follow-up was needed in some cases. The study included 90 female patients with their ages ranged from 32 to 70 years (mean age 47.18 賊 11.24 SD). Full-field digital mammography and digital breast tomosynthesis were followed by US examination done for all patients.
  • 4. Background Breast cancer incidence had increased by 20% with a possible increase of diagnosis before the age of 50. Cancer care had been individualized for patients, and thus, better characterization was required for treatment planning. Imaging examination is an important tool to help diagnose and decide therapeutic response.
  • 5. Screening mammography is considered the primary technique, and the most important screening tool in breast cancer detection and assessment. It was responsible for a reduction in mortality among the age group of 40 years or older. Initially, screen-film mammography was done, but today, the most common two-view examination (mediolateral oblique and craniocaudal) using full-field digital mammography (FFDM) used, searching for any mass, architectural distortion, or calcification, and then giving BIRADS score.
  • 6. Nevertheless, mammography suffers from several limitations due to the low contrast between tumors and surrounding tissue. Especially in dense breasts, this can lead to a decrease in sensitivity, and added imaging methods are necessary . Advances in full-field digital mammography (FFDM) led to the development of digital breast tomosynthesis, which is a three-dimensional breast examination.
  • 7. The multi-view information from the multiple low-dose images used to generate thin slices (at 1-mm spacing) that viewed sequentially as a stack in orientation, e.g., craniocaudal, mediolateral oblique with the potential to improve accuracy by improving differentiation between malignant and non-malignant lesions
  • 8. The primary operational advantage of tomosynthesis is that the procedure is very similar to the conventional mammography examination in the technologists tasks and the woman being imaged, yet it eliminates the limitation of full-field digital mammography by overlapping breast tissue. Therefore, tomosynthesis is implied easily in the current clinical practices with minor operational adjustments
  • 9. Inclusion criteria Patients included in this study those referred from breast clinic for either: Screening purposes: whether primary screening or those who had already undergone treatment for breast cancer and were on yearly follow-up. Diagnostic purposes: women presenting with a palpable lump, or any other breast complaints such as nipple discharge or breast pain.
  • 10. Exclusion criteria: Pregnant and lactating women Those having open breast wounds
  • 11. FULL-FIELD DIGITAL MAMMOGRAPHY The technique of full-field digital mammography: During acquisition, the breast was compressed between breastplates and standard views medio lateral-oblique and craniocaudal views were taken for all patients.
  • 12. The technique of 3D tomosynthesis During acquisition, the breast was compressed between breastplates as in conventional mammography, and the X-ray tube pivoted in an arc that varies between 15属 (narrow range) and 60属 (wide range) in a plane aligned with the chest wall allowing for 11 to 15 low-dose projection images (2D) acquired for the tomosynthesis images.
  • 13. Images of the tomosynthesis were obtained in the same standard projections (craniocaudal and mediolateral oblique) as conventional screening mammography. Data from the low-dose projection 2D images used to reconstruct 1-mm-thick sections separated by 1-mm space to form the 3D volume of the compressed breast in the form of a series of images through the entire breast.
  • 14. Image analysis and interpretation Two experienced readers independently viewed and interpreted FFDM, synthetic 2D, and DBT. Each breast was evaluated about the presence of lesions or not, site of the lesions, type (mass, architectural distortion, focal asymmetry), margin definition, and 賊 calcifications. Finally, the BIRADS category of the lesions in the imaging modalities individually determined according to the BIRADS lexicon 2013 classification (Table 1), and all cases were also categorized by breast density (according to ACR guidelines edition 2013) and age group. The obtained data were correlated with ultrasound examination.
  • 15. The final diagnosis was obtained by histopathological assessment for lesions with BIRADS IV or more and those having BIRADS III further correlated with the ultrasound data, and then followed up (3 follow-up studies every 6 months). True positive and true negative were decided by further diagnostic work-up, which included other imaging studies by ultrasonography, histopathological examination, or follow-up.
  • 17. Results In the current study, patients were divided into four groups according to breast density and according to the age group.
  • 20. The distribution of different breast densities among different age groups is shown Out of the total 90 cases, 50 were diagnostic and 40 were screening cases.
  • 22. As regard lesion detection, classification, and BIRADS category for each case, FFDM detected lesions in 48/90 cases (53.3%) from which 39/48 cases were classified as with malignant lesions (30/48 cases were given BIRADS score IV, 4/48 cases were given BIRADS score V and 5/48 cases were given BIRADS score VI). On the other hand, 9/48 cases were classified as benign lesions (2/48 cases were given BIRADS score II, 7/48 cases were given BIRADS score III) and considered 42/90 cases as negative (BIRADS I).
  • 23. While DBT detected lesions in 73/90 cases (81.1%) from which classified 46/73 cases as with malignant lesions (25/73 cases were given BIRADS score IV, 16/73 cases were given BIRADS score V, 5/73 cases were given BIRADS score VI), whereas 27/73 cases were considered as with benign lesions (4/73 cases were given BIRADS score II, 23/73 patients were given BIRADS score III) and 17/90 cases as negative (BIRADS score I).
  • 25. With correlation with the final diagnosis 17 cases were true negative and 73 cases were true positive for the presence of breast lesions from which 45 cases were malignant with invasive duct carcinomas detected in 44/ 45(97.7%) and DCIS associated IDC in 1/45 (2.2%) with 28 cases were benign breast lesions ( cysts, fibroadenoma, duct ectasia, and intramammary LNs).
  • 26. By adding DBT to FFDM 52/90 cases were changed their BIRADS scoring as follows: 13 cases were upgraded from BIRADS I to IV, 14 cases were upgraded from BIRADS I to III, 12 cases were upgraded from BIRADS IV to V, and 4 cases were upgraded from BIRADS III to IV. Downgrading BIRADS scoring detected in 7 cases from IV to II and III and two cases were downgraded from BIRADS IV to I. In 38 cases, DBT did not change the BIRADS scoring, but its addition increased the diagnostic confidence and better evaluation of the lesions detected.
  • 27. After revising the results of FFDM with the final diagnosis by other modalities, histopathology, and/or close follow-up, 29 cases were true positive, 10 cases were false positive, 16 cases were false negative, and 35 cases were true negative. Diagnostic indices of mammography were a sensitivity of 64.44%, a specificity of 77.78%, a positive predictive value of 74.63%, a negative predictive value of 68.63%, and a diagnostic accuracy of 71.11%. While for DBT 45 cases were true positive, 1 case was false positive, no cases were false negative, and 44 cases were true negative. Diagnostic indices were a sensitivity of 100%, a specificity of 97.77%, a positive predictive value of 97.78%, anegative predictive value of 100%, and a diagnostic accuracy of 97.7%.
  • 36. Discussion Mammogram has been the gold standard technique and the mainstay for the detection of breast cancer over decades. Women with the dense breasts meet two major problems, as increased breast density decreases the sensitivity and specificity of mammography owing to a decrease in the contrast between tumor and surrounding breast tissue, and superimposed breast tissues may obscure lesions, resulting in a considerable number of false- negative mammograms.
  • 37. The dense breast itself is a risk factor for developing breast cancer. Tomosynthesis has evolved as advanced imaging technique for early diagnosis of breast lesions with a promising role particularly in dense and treated breasts . Digital breast tomosynthesis provides 3D imaging of the breast, so it reduces the superimposition of breast tissue and improves cancer detection. Previous studies showed that DBT improved the sensitivity, specificity, and accuracy of full-field digital mammography by reducing the recall rate and increasing the cancer detection rate
  • 38. Conclusion DBT is a promising imaging modality offering better detection and characterization of different breast abnormalities, especially in young females, and those with dense breasts with an increase of sensitivity and specificity than FFDM. This leads to a reduction in the recalled cases, negative biopsies, and assessing the efficacy of therapy as it enables improving detection of breast cancer and different breast lesions not visualized by conventional mammography.