Benign vs. malignant differentiation of well-circumscribed masses detected on Digital Breast Tomosynthesis
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目的;Digital breast tomosynthesis(以下DBT)で指摘された境界明瞭平滑腫瘤(Well circumscribed mass;以下WCM)の良悪性に関わる画像所見を検討した。対象及び方法;2016年7月から2021年3月までDBT でWCM を認めた555病変,平均年齢55才。撮影機腫は富士フィルムAMULET Innovality でMLO,CC 撮影を行った。最終診断は良性,悪性(がん)に分け,Digital mammography(以下DM)所見,DBT 所見を検討した。 結果;内訳は555病変中悪性は24病変(4.3%),DM 所見C1が41.6%,うち3.5%に悪性を認めた。良悪性の鑑別としてDBT での最長径,最長/最短径比,腫瘤濃度が単変量解析での有意因子,腫瘤濃度のみが多変量解析で独立有意因子であった。腫瘤濃度による,がんの診断能は正診率77.1%,感度45.8%,PPV8.8%。一方,感度を重要視すると,最長径7.9mm 以上を悪性とした場合,感度100%,特異度38.6%,正診率41.3%,PPV6.9%,NPV100%であった。 結語;WCM の約95%は良性病変であり,7.9mm 未満の小病変を除外することで,がんを見落とさずに偽陽性率を低下させることができる可能性が示唆された。Keywords:
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Digital Breast Tomosynthesis
To investigate the contribution of breast tomosynthesis to intraoperative specimen evaluation in subjects with breast cancer. Approval was obtained from the hospital ethics committee. Specimen mammography, tomosynthesis, and, if available, ultrasonography images were retrospectively assessed for 208 women who had undergone conservative surgery at our hospital between January 2013 and April 2016 after being diagnosed with breast cancer. The success of mammography, tomosynthesis, and ultrasonography in lesion detection and characterization was evaluated. Of 208 lesions, 142 (68.3%) and 198 (95.2%) were detected by mammography and tomosynthesis, respectively. All lesions were detected in 150 subjects undergoing ultrasonography (124 dense breasts, 26 fatty breasts). In 84 women who had fatty breasts, all lesions were detected both by mammography and by tomosynthesis. In 124 women with dense breasts, lesions were detected by mammography in 59 (48%) and in 114 (92%) by tomosynthesis. The success of tomosynthesis in lesion detection was found to be markedly higher than mammography (P = .00). In conclusion, tomosynthesis contributed to mammography in specimen evaluation in a total of 101 subjects. The success of tomosynthesis in lesion detection and characterization during intraoperative specimen evaluation is higher than mammography. In daily practice, ultrasonography is performed for lesions which cannot be evaluated by specimen mammography due to dense parenchymal pattern. Tomosynthesis may reduce the need for and the time and workforce allocated to specimen ultrasonography in an important group of subjects.
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The aim of the study was to compare the performance of full-field digital mammography (FFDM), digital breast tomosynthesis and a dedicated digital specimen radiography system (SRS) in consecutive patients, and to compare the margin status of resected lesions versus pathological assessment.Resected tissue specimens from consecutive patients who underwent intraoperative breast specimen assessment following wide local excision or oncoplastic breast conservative surgery were examined by FFDM, tomosynthesis and SRS. Two independent observers retrospectively evaluated the visibility of lesions, size, margins, spiculations, calcifications and diagnostic certainty, and chose the best performing method in a blinded manner.We evaluated 216 specimens from 204 patients. All target malignant lesions were removed with no tumouron-ink. One papilloma had positive microscopic margins and one patient underwent reoperation owing to extensive in situ components. There were no significant differences in measured lesion size among the three methods. However, tomosynthesis was the most accurate modality when compared with the final pathological report. Both observers reported that tomosynthesis had significantly better lesion visibility than SRS and FFDM, which translated into a significantly greater diagnostic certainty. Tomosynthesis was superior to the other two methods in identifying spiculations and calcifications. Both observers reported that tomosynthesis was the best performing method in 76.9% of cases. The interobserver reproducibilities of lesion visibility and diagnostic certainty were high for all three methods.Tomosynthesis was superior to SRS and FFDM for detecting and evaluating the target lesions, spiculations and calcifications, and was therefore more reliable for assessing complete excision of breast lesions.
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Abstract Background As mammography has its known limitations in dense breast, additional imaging is usually needed. We aimed to evaluate the role of automated breast ultrasound in addition to tomosynthesis in detection and diagnosis of breast lesions in dense breasts. Seventy patients with dense breasts subjected to full-field digital mammography (FFDM) including digital breast tomosynthesis (DBT) and automated breast ultrasound (ABUS). Both studies were evaluated by two experienced radiologists to assess breast composition, mass characterization, asymmetry, calcification, axillary lymphadenopathy, extent of disease (EOD), skin thickening, retraction, architectural distortion, and BIRADS classification. All breast masses were interpreted as above described and then correlated with final pathological diagnosis. Results Study included 70 females presenting with different types of breast lesions. Eighty-two masses were detected: 53 benign ( n = 53/82), 29 malignant ( n = 29/82). Histopathology of the masses was reached by core biopsy ( n = 30), FNAC ( n = 14), and excisional biopsy ( n = 11). The rest of the masses ( n = 27/82) were confirmed by their characteristic sonographic appearances; 20 cases of multiple bilateral anechoic simple cysts, 7 typical fibroadenomas showed stationary course on follow-up. As regards the final BIRADS score given for both modalities, tomosynthesis showed accuracy of 93.1% in characterization of malignant masses with accuracy of 94.3% in benign masses, on the other hand automated ultrasound showed 100% accuracy in characterization of malignant masses with 98.1% accuracy in benign masses. Conclusion Adding ABUS to tomosynthesis has proven a valuable imaging tool for characterization of breast lesions in dense breasts both as screening and diagnostic tool. They proved to be more sensitive and specific than digital mammography alone in showing tissue overlap, tumor characterization, lesion margins, extent, and multiplicity of malignant lesions.
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Mammography has been the standard screening method for breast cancer. In women with suspicious calcifications and architectural distortion identified on mammography or digital breast tomosynthesis only without detected on breast US, stereotactic biopsy and mammography-guided preoperative localization is one of the method for pathologic diagnosis. This review aims to describe the indication, contraindication, technique of stereotactic biopsy, clip placement after stereotactic biopsy, and digital breast tomosynthesis-guided stereotactic biopsy. In addition, this article reviews mammography-guided preoperative localization using a wire or non-wire device.
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Abstract OBJECTIVE: Vacuum-assisted breast biopsy (VABB) has replaced surgical biopsy for the assessment of mammographic abnormalities that are not evident clinically and or on ultrasound examination. The aim of this study was to determine the indications for, and accuracy of, vacuum-assisted breast biopsy (VABB) performed using digital breast tomosynthesis (DBT) guidance. (Hologic® Dimensions, Affirm guidance and Eviva handsets). MATERIALS AND METHODS: Design: Retrospective medical record and histopathologic review. Patients and method: We introduced DBT guided VABB in June 2014 having previously investigated such patients using the prone table technique. This is a review of the first 66 consecutive patients investigated using this technique up to April 2105. The following information was reviewed: Indication for VABB, (mammographic classification M1-5, type of abnormality – calcifications/mass/distortion), complications of the procedure itself, (failure to complete, infection, haematoma), the result of the multidisciplinary team (MDT) review of imaging/pathologic correlation and the outcome for the patient. RESULTS: In one case it proved impossible to locate the lesion and this patient has been excluded from further analysis. The mean age of the patients was 57 years (30-80years). VABB was proposed for patients with lesions initially reported as highly suspicious (M5) 4 patients (6%), suspicious (M4) in 18 patients (28%), intermediate (M3) in 37 patients (57%) or benign (M2) in 6 patients (9%). Mean size of the lesion was 13mm (range 3-100mm). Forty-four patients (68%) presented with micro calcifications, 14 (21%) with distortions in and 7 (11%) with masses. There were no complications (infection or haematoma) that required further management following the procedure. Review by the MDT agreed that all biopsies were adequate and removed representative tissue from the lesion (No B1s). Review showed that the histology was benign and consistent in 30 (46%) patients all of whom were discharged to routine screening. 19 (29%) cases were reported as B3 (ADH, flat atypia, LCIS or ALH) in whom all the calcifications had been removed in 13 (20%) and the patients discharged and 6 (9%) went to open biopsy for residual calcifications all of whom were benign on final analysis. There was one (1.5%) radial scar reported as B4 that went to open excision and proved benign. 15 (23%) proved malignant (B5a, B5b) and went on to definitive treatment (with one patient entered into the LORIS low risk DCIS trial). The procedure is quicker, more accurate (related to the higher resolution and larger window of the receptor plate) and involves less radiation exposure (often involving only one DBT exposure) when compared to performing the same procedure on the Hologic Platinum prone table. CONCLUSION: DBT-guided VABB is an accurate, convenient and safe procedure. Citation Format: Munir A, Moalla A, Williams HR, Thomas D, Huws AM, Holt SD. A review of 66 consecutive patients investigated for mammographic abnormalities by digital tomosynthesis guided vacuum assisted breast biopsy. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-02-02.
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Purpose To assess the feasibility and accuracy of digital breast tomosynthesis (DBT)–guided needle localization for DBT-detected suspicious abnormalities not visualized with other modalities and to analyze the imaging and pathologic characteristics of abnormalities detected only with DBT to determine the positive predictive value for malignancy. Materials and Methods This HIPAA-compliant study was approved by the institutional review board, and the requirement to obtain informed consent was waived. A retrospective query of the imaging database identified 34 consecutive women (average age, 55 years; age range, 28–84 years) with 36 lesions who underwent DBT-guided needle localization between April 2011 and January 2013 with use of commercially available equipment. Imaging findings and medical records were reviewed. Findings that were attributable to previous surgical changes were classified as benign or probably benign and excluded from analysis because the lesions did not proceed to localization. Results Architectural distortion was the imaging finding identified in all 36 abnormalities (100%). Findings from pathologic examination after the first attempt at localization were concordant with those from imaging in 35 of the 36 lesions (97%), which is suggestive of appropriate sampling. Histologic findings were malignant in 17 of the 36 lesions (47%; 95% confidence interval: 30.4%, 64.5%). Thirteen of the 17 lesions (76%; 95% confidence interval: 50.1%, 93.1%) were invasive malignancies. Twenty-two of the 36 abnormalities (61%) were either malignant or high-risk lesions (atypical ductal hyperplasia, lobular carcinoma in situ, atypical lobular hyperplasia). Conclusion DBT-guided needle localization is an accurate and feasible method with which to biopsy DBT-detected suspicious architectural distortions not visualized at mammography or sonography. The high risk of malignancy in abnormalities detected only with DBT (47%) confirms that routine biopsy is required for histologic analysis. © RSNA, 2015 Online supplemental material is available for this article.
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