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Calcifications on DBT and Synthetic Views: Update and Management Strategies

  • Breast Imaging (H Ojeda-Fournier and A Chong, Section Editors)
  • Published:
Current Radiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To provide an update on imaging appearance of calcifications on digital breast tomosynthesis (DBT) compared to digital mammography (DM), and discuss the challenges in interpretation of DBT and synthesized views (SM).

Recent Findings

The quasi-3D feature of DBT reduces tissue overlap compared to DM improving visualization of lesions. However, early studies suggest that calcifications are less conspicuous on DBT. Two-dimensional SM created from tomosynthesis acquisition are FDA approved to replace DM and demonstrate improved conspicuity of calcifications. Reader and population-based studies suggested overall similar performance for SM+DBT when compared to DM+DBT. Reconstruction algorithms have improved calcification visualization; however, visualization of some calcifications can be challenging. On the other hand, DBT is increasingly being used for guiding biopsy of calcifications with increased success rate.

Summary

Knowledge of the advantages and challenges of DBT and SM helps improve detection of suspicious calcifications while decreasing false-positive results. Improved lesion localization and shorter procedure time are major advantageous of DBT-guided biopsy of calcifications.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance and •• Of major importance

  1. • McDonald ES, McCarthy AM, Akhtar AL, Synnestvedt MB, Schnall M, Conant EF. Baseline screening mammography: performance of full-field digital mammography versus digital breast tomosynthesis. AJR Am J Roentgenol. 2015;205(5):1143–8. Both studies show overall superior performance of DBT compared to DM for improving cancer detection and reducing the recall rate.

    PubMed  Google Scholar 

  2. • Conant EF, Barlow WE, Herschorn SD, et al. Association of digital breast tomosynthesis vs digital mammography with cancer detection and recall rates by age and breast density. JAMA Oncol. 2019;5(5):635–42. Both studies show overall superior performance of DBT compared to DM for improving cancer detection and reducing the recall rate.

    PubMed  PubMed Central  Google Scholar 

  3. Shin SU, Chang JM, Bae MS, et al. Comparative evaluation of average glandular dose and breast cancer detection between single-view digital breast tomosynthesis (DBT) plus single-view digital mammography (DM) and two-view DM: correlation with breast thickness and density. Eur Radiol. 2015;25(1):1–8.

    PubMed  Google Scholar 

  4. Vedantham S, Karellas A, Vijayaraghavan GR, Kopans DB. Digital breast tomosynthesis: state of the art. Radiology. 2015;277(3):663–84.

    PubMed  PubMed Central  Google Scholar 

  5. Wallis MG, Moa E, Zanca F, Leifland K, Danielsson M. Two-view and single-view tomosynthesis versus full-field digital mammography: high-resolution X-ray imaging observer study. Radiology. 2012;262(3):788–96.

    PubMed  Google Scholar 

  6. Rafferty EA, Park JM, Philpotts LE, et al. Assessing radiologist performance using combined digital mammography and breast tomosynthesis compared with digital mammography alone: results of a multicenter, multireader trial. Radiology. 2013;266(1):104–13.

    PubMed  PubMed Central  Google Scholar 

  7. Rafferty EA, Durand MA, Conant EF, et al. Breast cancer screening using tomosynthesis and digital mammography in dense and nondense breasts. JAMA. 2016;315(16):1784–6.

    PubMed  Google Scholar 

  8. • Schrading S, Distelmaier M, Dirrichs T, et al. Digital breast tomosynthesis-guided vacuum-assisted breast biopsy: initial experiences and comparison with prone stereotactic vacuum-assisted biopsy. Radiology. 2015;274(3):654–62. Demonstrates the technique and performance of DBT for guiding biopsy.

  9. Durand MA. Synthesized mammography: clinical evidence, appearance, and implementation. Diagnostics (Basel). 2018;8(2):22.

    Google Scholar 

  10. Skaane P, Bandos AI, Gullien R, et al. Prospective trial comparing full-field digital mammography (FFDM) versus combined FFDM and tomosynthesis in a population-based screening programme using independent double reading with arbitration. Eur Radiol. 2013;23(8):2061–71.

    PubMed  PubMed Central  Google Scholar 

  11. •• Zuckerman SP, Conant EF, Keller BM, et al. Implementation of synthesized two-dimensional mammography in a population-based digital breast tomosynthesis screening program. Radiology. 2016;281(3):730–6. Documenting the similar performance of DBT+SM compared to DM.

  12. •• Skaane P, Bandos AI, Eben EB, et al. Two-view digital breast tomosynthesis screening with synthetically reconstructed projection images: comparison with digital breast tomosynthesis with full-field digital mammographic images. Radiology. 2014;271(3):655–63. Documenting the similar performance of DBT+SM compared to DM.

  13. •• Bernardi D, Macaskill P, Pellegrini M, et al. Breast cancer screening with tomosynthesis (3D mammography) with acquired or synthetic 2D mammography compared with 2D mammography alone (STORM-2): a population-based prospective study. Lancet Oncol. 2016;17(8):1105–13. Documenting the similar performance of DBT+SM compared to DM.

    PubMed  Google Scholar 

  14. Zuckerman SP, Sprague BL, Weaver DL, Herschorn SD, Conant EF. Survey results regarding uptake and impact of synthetic digital mammography with tomosynthesis in the screening setting. J Am Coll Radiol. 2020;17(1 Pt A):31–7.

    PubMed  Google Scholar 

  15. High definition breast tomosynthesis trust in what you see—at the widest angle. https://www.healthcare.siemens.com/mammography/tomosynthesis/get-insight (2018). Accessed 5 Feb 2020

  16. Andrew S. Design considerations in optimizing a breast tomosynthesis system. https://hologiced.com/assets/Design_Considerations_Optimizing_Breast_Tomo.pdf (2018). Accessed 5 Feb 2020.

  17. Dodelzon K, Simon K, Dou E, et al. Performance of 2D synthetic mammography versus digital mammography in the detection of microcalcifications at screening. AJR Am J Roentgenol. 2020;7:1–9.

    Google Scholar 

  18. Choi JS, Han BK, Ko EY, Kim GR, Ko ES, Park KW. Comparison of synthetic and digital mammography with digital breast tomosynthesis or alone for the detection and classification of microcalcifications. Eur Radiol. 2019;29(1):319–29.

    PubMed  Google Scholar 

  19. Gilbert FJ, Tucker L, Gillan MG, et al. The TOMMY trial: a comparison of TOMosynthesis with digital MammographY in the UK NHS Breast Screening Programme—a multicentre retrospective reading study comparing the diagnostic performance of digital breast tomosynthesis and digital mammography with digital mammography alone. Health Technol Assess. 2015;19(4):1–136.

    PubMed  PubMed Central  Google Scholar 

  20. Brandt KR, Craig DA, Hoskins TL, et al. Can digital breast tomosynthesis replace conventional diagnostic mammography views for screening recalls without calcifications? A comparison study in a simulated clinical setting. AJR Am J Roentgenol. 2013;200(2):291–8.

    PubMed  Google Scholar 

  21. Nelson JS, Wells JR, Baker JA, Samei E. How does c-view image quality compare with conventional 2D FFDM? Med Phys. 2016;43(5):2538.

    PubMed  Google Scholar 

  22. Spangler ML, Zuley ML, Sumkin JH, et al. Detection and classification of calcifications on digital breast tomosynthesis and 2D digital mammography: a comparison. AJR Am J Roentgenol. 2011;196(2):320–4.

    PubMed  Google Scholar 

  23. Gilbert FJ, Tucker L, Gillan MG, et al. Accuracy of digital breast tomosynthesis for depicting breast cancer subgroups in a UK Retrospective Reading Study (TOMMY Trial). Radiology. 2015;277(3):697–706.

    PubMed  Google Scholar 

  24. Freer PE, Riegert J, Eisenmenger L, et al. Clinical implementation of synthesized mammography with digital breast tomosynthesis in a routine clinical practice. Breast Cancer Res Treat. 2017;166(2):501–9.

    PubMed  Google Scholar 

  25. Gur D, Zuley ML, Anello MI, et al. Dose reduction in digital breast tomosynthesis (DBT) screening using synthetically reconstructed projection images: an observer performance study. Acad Radiol. 2012;19(2):166–71.

    PubMed  Google Scholar 

  26. •• Hofvind S, Hovda T, Holen AS, et al. Digital breast tomosynthesis and synthetic 2D mammography versus digital mammography: evaluation in a population-based screening program. Radiology. 2018;287(3):787–94. Shows sufficient performance of SM and DBT for detecting suspicious calcifications.

  27. Li J, Zhang H, Jiang H, et al. Diagnostic performance of digital breast tomosynthesis for breast suspicious calcifications from various populations: a comparison with full-field digital mammography. Comput Struct Biotechnol J. 2019;17:82–9.

    PubMed  Google Scholar 

  28. Kopans D, Gavenonis S, Halpern E, Moore R. Calcifications in the breast and digital breast tomosynthesis. Breast J. 2011;17(6):638–44.

    PubMed  Google Scholar 

  29. Rominger M, Wisgickl C, Timmesfeld N. Breast microcalcifications as type descriptors to stratify risk of malignancy: a systematic review and meta-analysis of 10665 cases with special focus on round/punctate microcalcifications. Rofo. 2012;184(12):1144–52.

    CAS  PubMed  Google Scholar 

  30. Roth RG, Maidment AD, Weinstein SP, Roth SO, Conant EF. Digital breast tomosynthesis: lessons learned from early clinical implementation. Radiographics. 2014;34(4):E89–102.

    PubMed  PubMed Central  Google Scholar 

  31. Friedewald SM. Breast tomosynthesis: practical considerations. Radiol Clin North Am. 2017;55(3):493–502.

    PubMed  Google Scholar 

  32. Linden SS, Sickles EA. Sedimented calcium in benign breast cysts: the full spectrum of mammographic presentations. AJR Am J Roentgenol. 1989;152(5):967–71.

    CAS  PubMed  Google Scholar 

  33. Nalawade YV. Evaluation of breast calcifications. Indian J Radiol Imaging. 2009;19(4):282–6.

    PubMed  PubMed Central  Google Scholar 

  34. Peppard HR, Nicholson BE, Rochman CM, Merchant JK, Mayo RC 3rd, Harvey JA. Digital breast tomosynthesis in the diagnostic setting: indications and clinical applications. Radiographics. 2015;35(4):975–90.

    PubMed  Google Scholar 

  35. Lai KC, Slanetz PJ, Eisenberg RL. Linear breast calcifications. AJR Am J Roentgenol. 2012;199(2):W151–W157157.

    PubMed  Google Scholar 

  36. Hofvind S, Iversen BF, Eriksen L, Styr BM, Kjellevold K, Kurz KD. Mammographic morphology and distribution of calcifications in ductal carcinoma in situ diagnosed in organized screening. Acta Radiol. 2011;52(5):481–7.

    PubMed  Google Scholar 

  37. Ho CP, Tromans C, Schnabel JA, Brady M. Classification of clusters of microcalcifications in digital breast tomosynthesis. Conf Proc IEEE Eng Med Biol Soc. 2010;2010:3166–9.

    PubMed  Google Scholar 

  38. Waldherr C, Berclaz G, Altermatt HJ, et al. Tomosynthesis-guided vacuum-assisted breast biopsy: a feasibility study. Eur Radiol. 2016;26(6):1582–9.

    PubMed  Google Scholar 

  39. Rochat CJ, Baird GL, Lourenco AP. Digital mammography stereotactic biopsy versus digital breast tomosynthesis-guided biopsy: differences in biopsy targets, pathologic results, and discordance rates. Radiology. 2020;294(3):518–27.

    PubMed  Google Scholar 

  40. Bahl M, Maunglay M, D'Alessandro HA, Lehman CD. Comparison of upright digital breast tomosynthesis-guided versus prone stereotactic vacuum-assisted breast biopsy. Radiology. 2019;290(2):298–304.

    PubMed  Google Scholar 

  41. Horvat JV, Keating DM, Rodrigues-Duarte H, Morris EA, Mango VL. Calcifications at digital breast tomosynthesis: imaging features and biopsy techniques. Radiographics. 2019;39(2):307–18.

    PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Breast Imaging Division, UC San Diego Health, Koman Family Outpatient Pavilion, 9400 Campus Point Dr, La Jolla, San Diego, CA, 92037, USA

    Azadeh Elmi, Rebecca Rakow-Penner, Alice Chong, Mohammad Eghtedari, William Ladd, Vivian Lim & Haydee Ojeda-Fournier

  2. Eisenhower Medical Center, Lucy Curci Cancer Center, Rancho Mirage, CA, USA

    Azadeh Elmi

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  1. Azadeh Elmi
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  2. Rebecca Rakow-Penner
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Correspondence to Azadeh Elmi.

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Drs. Elmi, Rakow-Penner, Ladd, Lim, and Eghtedari declare no potential conflicts of interest. Drs. Ojeda and Chong are section editors for Current Radiology Reports.

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Elmi, A., Rakow-Penner, R., Chong, A. et al. Calcifications on DBT and Synthetic Views: Update and Management Strategies. Curr Radiol Rep 8, 9 (2020). https://doi.org/10.1007/s40134-020-00352-4

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