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European Radiology

, Volume 20, Issue 1, pp 16–24 | Cite as

Breast tomosynthesis in clinical practice: initial results

  • Hendrik J. Teertstra
  • Claudette E. Loo
  • Maurice A. A. J. van den Bosch
  • Harm van Tinteren
  • Emiel J. T. Rutgers
  • Sara H. Muller
  • Kenneth G. A. Gilhuijs
Breast

Abstract

The purpose of this study was to assess the potential value of tomosynthesis in women with an abnormal screening mammogram or with clinical symptoms. Mammography and tomosynthesis investigations of 513 woman with an abnormal screening mammogram or with clinical symptoms were prospectively classified according to the ACR BI-RADS criteria. Sensitivity and specificity of both techniques for the detection of cancer were calculated. In 112 newly detected cancers, tomosynthesis and mammography were each false-negative in 8 cases (7%). In the false-negative mammography cases, the tumor was detected with ultrasound (n = 4), MRI (n = 2), by recall after breast tomosynthesis interpretation (n = 1), and after prophylactic mastectomy (n = 1). Combining the results of mammography and tomosynthesis detected 109 cancers. Therefore in three patients, both mammography and tomosynthesis missed the carcinoma. The sensitivity of both techniques for the detection of breast cancer was 92.9%, and the specificity of mammography and tomosynthesis was 86.1 and 84.4%, respectively. Tomosynthesis can be used as an additional technique to mammography in patients referred with an abnormal screening mammogram or with clinical symptoms. Additional lesions detected by tomosynthesis, however, are also likely to be detected by other techniques used in the clinical work-up of these patients.

Keywords

Breast Mammography Tomosynthesis Cancer Detection 

Notes

Acknowledgements

This study was supported by a grant from Hologic Inc., Bedford, MA. We are grateful to Angelique Schlief for preparing the database and to Loren Niklason (Hologic) for critically proof-reading the manuscript.

Conflict of interest declared

Grant From Hologic Inc. to H.J. Teertstra.

References

  1. 1.
    Singletary SE, Allred C, Ashley P et al (2003) Staging system for breast cancer: revisions for the 6th edition of the AJCC Cancer Staging Manual. Surg Clin North Am 83:803–819CrossRefPubMedGoogle Scholar
  2. 2.
    Wallis MG, Walsh MT, Lee JR (1991) A review of false negative mammography in a symptomatic population. Clin Radiol 44:13–15CrossRefPubMedGoogle Scholar
  3. 3.
    Coveney EC, Geraghty JG, O’Laide R et al (1994) Reasons underlying negative mammography in patients with palpable breast cancer. Clin Radiol 49:123–125CrossRefPubMedGoogle Scholar
  4. 4.
    Joensuu H, Asola R, Holli K et al (1994) Delayed diagnosis and large size of breast cancer after a false negative mammogram. Eur J Cancer 30:1299–1302CrossRefGoogle Scholar
  5. 5.
    Chew SB, Hughes M, Kennedy C, Gillett D, Carmalt H (1996) Mammographically negative breast cancer at the Strathfield Breast Centre. Aust N Z J Surg 66:134–137CrossRefPubMedGoogle Scholar
  6. 6.
    Moss HA, Britton PD, Flower CD et al (1999) How reliable is modern breast imaging in differentiating benign from malignant breast lesions in a symptomatic population? Clin Radiol 54:676–682CrossRefPubMedGoogle Scholar
  7. 7.
    Kolb TM, Lichy J, Newhouse JH (2002) Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology 225:165–175CrossRefPubMedGoogle Scholar
  8. 8.
    Flobbe K, Bosch AM, Kessels AG et al (2003) The additional diagnostic value of ultrasonography in the diagnosis of breast cancer. Arch Intern Med 163:1194–1199CrossRefPubMedGoogle Scholar
  9. 9.
    Benson SR, Blue J, Judd K, Harman JE (2004) Ultrasound is now better than mammography for the detection of invasive breast cancer. Am J Surg 188:381–385CrossRefPubMedGoogle Scholar
  10. 10.
    Berg WA, Gutierrez L, NessAiver MS, Carter WB, Bhargavan M, Lewis RS, Ioffe OB (2004) Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology 233:830–849CrossRefPubMedGoogle Scholar
  11. 11.
    Murphy IG, Dillon MF, Doherty AO, McDermott EW, Kelly G, O'Higgins N, Hill AD (2007) Analysis of patients with false negative mammography and symptomatic breast carcinoma. J Surg Oncol 96:457–463CrossRefPubMedGoogle Scholar
  12. 12.
    Kneeshaw PJ, Turnbull LW, Drew PJ (2003) Current applications and future direction of MR mammography. Br J Cancer 88:4–10CrossRefPubMedGoogle Scholar
  13. 13.
    Kuhl CK (2007) Current status of breast MR imaging. Part 2. Clinical applications. Radiology 244:672–691CrossRefPubMedGoogle Scholar
  14. 14.
    Orel S (2008) Who should have breast magnetic resonance imaging evaluation? J Clin Oncol 26:703–11CrossRefPubMedGoogle Scholar
  15. 15.
    D'Orsi CJ, Newell MS (2007) Digital mammography: clinical implementation and clinical trials. Semin Roentgenol 42:236–242CrossRefPubMedGoogle Scholar
  16. 16.
    Rafferty EA (2007) Digital mammography: novel applications. Radiol Clin North Am 45:831–843CrossRefPubMedGoogle Scholar
  17. 17.
    Pisano ED, Gatsonis C, Hendrick E et al (2005) Digital Mammographic Imaging Screening Trial (DMIST) Investigators Group: diagnostic performance of digital versus film mammography for breast-cancer screening. N Engl J Med 353:1773–1783CrossRefPubMedGoogle Scholar
  18. 18.
    Pisano ED, Hendrick RE, Yaffe MJ et al (2008) Diagnostic accuracy of digital versus film mammography: exploratory analysis of selected population subgroups in DMIST. Radiology 246:376–383CrossRefPubMedGoogle Scholar
  19. 19.
    Park JM, Franken EA Jr, Garg M, Fajardo LL, Niklason LT (2007) Breast tomosynthesis: present considerations and future applications. Radiographics 27:S231–S240CrossRefPubMedGoogle Scholar
  20. 20.
    Lewin JM, Niklason L (2007) Advanced applications of digital mammography: breast tomosynthesis and contrast-enhanced digital mammography. Semin Roentgenol 42:243–252CrossRefPubMedGoogle Scholar
  21. 21.
    Poplack SP, Tosteson TD, Kogel CA, Nagy HM (2007) Digital breast tomosynthesis: initial experience in 98 women with abnormal digital screening mammography. Am J Roentgenol 189:616–623CrossRefGoogle Scholar
  22. 22.
    Niklason LT, Christian BT, Niklason LE et al (1997) Digital breast tomosynthesis in breast imaging. Radiology 205:399–406PubMedGoogle Scholar
  23. 23.
    Good WF, Abrams GS, Catullo VJ, Chough DM, Ganott MA, Hakim CM, Gur D (2008) Digital breast tomosynthesis: a pilot observer study. AJR Am J Roentgenol 190(4):865–869CrossRefPubMedGoogle Scholar
  24. 24.
    Andersson I, Ikeda DM, Zackrisson S, Ruschin M, Svahn T, Timberg P, Tingberg A (2008) Breast tomosynthesis and digital mammography: a comparison of breast cancer visibility and BIRADS classification in a population of cancers with subtle mammographic findings. Eur Radiol 18(12):2817–2825CrossRefPubMedGoogle Scholar
  25. 25.
    Hendrick RE, Bassett L, Botsco MA et al (1999) Mammography quality control manual. American College of Radiology, RestonGoogle Scholar
  26. 26.
    Boone JM (1999) Glandular breast dose for monoenergetic and high-energy x-ray beams: Monte Carlo assessment 1. Radiology 213:23–37PubMedGoogle Scholar
  27. 27.
    Liberman L, Menell JH (2002) Breast imaging reporting and data system (BI-RADS). Radiol Clin North Am 40:409–430CrossRefPubMedGoogle Scholar
  28. 28.
    D'Orsi CJ, Newell MS (2007) BI-RADS decoded: detailed guidance on potentially confusing issues. Radiol Clin North Am 45:751–763CrossRefPubMedGoogle Scholar
  29. 29.
    Chen SC, Carton AK, Albert M, Conant EF, Schnall MD, Maidment AD (2007) Initial clinical experience with contrast-enhanced digital breast tomosynthesis. Acad Radiol 14:229–238CrossRefPubMedGoogle Scholar
  30. 30.
    Kaas R, Kroger R, Hendriks JH et al (2004) The significance of circumscribed malignant mammographic masses in the surveillance of BRCA 1/2 gene mutation carriers. Eur Radiol 14:1647–1653CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2009

Authors and Affiliations

  • Hendrik J. Teertstra
    • 1
  • Claudette E. Loo
    • 1
  • Maurice A. A. J. van den Bosch
    • 1
  • Harm van Tinteren
    • 2
  • Emiel J. T. Rutgers
    • 3
  • Sara H. Muller
    • 1
  • Kenneth G. A. Gilhuijs
    • 1
  1. 1.Division of RadiologyThe Netherlands Cancer Institute-Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  2. 2.Division of BiostatisticsThe Netherlands Cancer Institute-Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  3. 3.Division of SurgeryThe Netherlands Cancer Institute-Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands

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