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"The value of breast tomosynthesis in the assessment ofBIRADS 3 lesions"

Poster No.: C-1905

Congress: ECR 2014

Type: Scientific Exhibit

Authors: N. Prvulovic Bunovic1, M. Prvulovic1, D. Djilas-Ivanovic1, K.

Koprivsek2; 1Sremska Kamenica/RS, 2Sremska Kamenica/NoviSad/RS

Keywords: Breast, Mammography, Diagnostic procedure, Technical aspects,Neoplasia

DOI: 10.1594/ecr2014/C-1905

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Aims and objectives

According to the recommendations of the American College of Radiology (ACR) weaccepted BIRADS (Breast Imaging Reporting and Data System) as a quality assurancetooland standardized mammography reports. Each lesion was classified according to BIRADS descriptors for masses (margins and shape) and calcifications (morphology anddistribution) and was categorized by the BI RADS final assessment categories (numericvalue 0-6). All breast findings should be differentiated in terms of benign or malignant,and the final impression needs to clearly state the degree of suspicion for malignancy andoffer recommendations for further management based on the BI RADS classification.InBI RADS 3 category which is "probably benign" we classified breast changes or lesionswith a probability of benign nature in 98 percent or more and all these cases were followedup by mammography at 6 months period.Mammography is the primary imaging modality in the evaluation of breast lesions,especially cancers. In the detection and characterisation of benign masses it usuallyrequired additional mammographic views or further research by other imaging modality.Tomosynthesis (TS) is new diagnostic techniques in breast evaluations with a promisingrole in rising sensitivity and specificity of digital mammography (DM).The purpose of this study was to assessed the diagnostic significance of tomosynthesisafter digital mammography detected BIRADS 3 lesions.

Methods and materials

The study was prospective and conducted at Oncology Institute, Department ofDiagnostic Imaging at Sremska Kamenica, Serbia, between March 2009 to August 2013.We performed TS in 360 DM detected BIRADS3 lesions. We evaluated breasts duringscreening and after diagnostic exam on the Hologic Selenia Dimensions system. Theradiologist independently reads DM and TS. As a part of the diagnostic procedure,after the mammography examination, in some patients core biopsy under ultrasound orstereotactic biopsies were performed. Most patients were followed up over a period of 2or more years. All mammograms were classified as BIRADS1-5 category after TS.

Results

Are shown in TABLE 1 and 2

Only 22.8% of BIRADS3 lesions (82/360) did not change within the category afterTS. After TS, 77.2% (278/360) digital mammography noticed lesions were re-classified

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according to the BIRADS system. TS "downstaged" to BIRADS1 or 2 category themajority of cases (263/360) and "upstaged" 15 cases to BIRADS4 and 5.

At the follow-up studies two-thirds of the DM detected BIRADS 3 lesions were"downstage" to BIRADS 1, 2 or stay in BIRADS 3 category and were stable in at leastduring the 2 year period.

We performed a biopsy in all suspected findings on Tomosynthesis. TS detected 6cancers in 9 lesions BIRADS4 category and in all 6 lesions classified into BIRADS5.

Images for this section:

Table 1: Table 1 and Table 2

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Conclusion

Our results indicated that TS in BIRADS 3 category were performed after DM"downstage" in two-thirds of cases. It significantly reduced the need for additionalmammographic views and frequent follow up studies. TS did not show any false-negative results in this study and it did not miss any cancers.In addition, reductionof numerous mammographic controls examination reduces the stress levels inwomen.Therefore, Tomosynthesis should be applied in the diagnostic algorithm inpatients with mammography detected BIRADS3 lesions.

Images for this section:

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Fig. 1: Case 1 DM L CC Mass in the upper outer quadrant of the left breast, BI RADS3 on DM, BI RADS 5 on TS

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Fig. 2: Case 1 DM L MLO Mass in the upper outer quadrant of the left breast, BI RADS3 on DM, BI RADS 5 on TS

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Fig. 3: Case 1 TS L CC Mass in the upper outer quadrant of the left breast, BI RADS3 on DM, BI RADS 5 on TS

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Fig. 4: Case 1 DM L MLO Mass in the upper outer quadrant of the left breast, BI RADS3 on DM, BI RADS 5 on TS

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Personal information

Nataša Prvulovi# Bunovi#, Radiologist

e-mail : prvulovicn@gmail.com

References

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