Aims and objectives
Increase breast density reduces mammographic accuracy and supplemental screening is recommended,
mainly with ultrasound (WBUS) and/or tomosynthesis(DBT).
Both methods increase invasive cancer detection,
when added to digital mammography (DM).
Single and multicenter studies have demonstrated that ultrasound screening can detect small additional cancers - median of 4.2/1000 exams-but with a low PPV for biopsies (Table 1)
On the other hand prospective and retrospective trials have shown that digital breast tomosynthesis (DBT) also detects additional invasive cancers -median of 2.0 /1000- mainly as architectural distortion,
being...
Methods and materials
This is an observational study in a clinical setting (non-academic institution) with a retrospective analysis of 6.
614 breast screening exams,
which included FFDM,
DBT and BUS,
from January 2012 to December 2015.
Most of the BUS and DBT exams weredone by the same physician,
on the same day as part of our standard protocol.The study was approved by the institution's research ethics committee
Inclusion criteria:
Asymptomatic women with negative DM
Breast density B,
C or D (according to ACR BI-RADS)
Median age 52 y/old...
Results
15 additional cancers were detected: 7 by US-only,
7 by US and DBT and 1 by DBT-only.
BUS detected 14 of 15 additional tumors and DBT detected 8 of them.
(Table 3).
Cancer detection rate was 5.6 for DM alone,
6.8 for DM plus DBT,
7.7 for DM plus USand 7.9 for DM plus DBT combined to US.
So,
the incremental cancer detection rate was 1.2 cancers by DBT,2.1 by USand 2.3 by DBT plus US,
per 1000 screening exams (Table 4)
All cancers detected...
Conclusion
Additional BUS or DBT improved CDR,
compared to DM alone,
with the highest incremental cancer detection achieved by thecombination of the two methods.
In women with breast density ACR B or C,
supplemental US screening detected more cancers than DBT.
All cancers detected by US-only were smaller than 1 cm and node negative but the method was time consuming and had a very low PPV.
Supplemental DBT screening detected 53.3% of all additional cancers,
although most of them were also seen by US.
Personal information
Our results were comparable to previous data in the literature and favored supplemental screening with US in women with dense breasts (ACR breast density C or D )
Howerever,
DBT can be considered an option for women with non-fatty breasts,
because detected half of all additional cancers,
with a higher PPV than US.
References
Scheel JR et al Am J Obstet Gynecol 2015; 212 : 9-17
Berg WA et al.
JAMA 2008;299: 2151-63
Corsetti V et al.
Eur J Cancer 2008;44:539-44
Hooley RJ et al.
Radiology 2012;265(1):59-69
Durand M,
Hooley RJ.
Radiol Clin N Am 2017;55:527-39
Skaane P et al.
Radiology 2013;267:47-56
Ciatto S et al.
Lancet 2013;14:583-9
Lang K et al.
Eur Radiol 2016;26:184
Friedewald A et al.
JAMA 2014;311: 2499-2507
Tagliafico AS et al.
JCO 2016;34:1882-8
Elizalde A et al.
Acta Radiologica 2016:57:13-18