Breast tomosynthesis state-of-the-art and review of the literature

A data set of 2-view DBT of 72 breasts containing micro-calcification clusters was collected from 72 subjects who were scheduled to undergo breast biopsy. A total of women underwent 2D DM including supplementary cone-down and magnification views and breast ultrasonography if indicated, as well as DBT.

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Automated Breast Ultrasound Ultrasound is a proven diagnostic tool in breast imaging; however, the limitations of traditional hand-held ultrasound HHUSwhich include operator-dependent variability and elevated acquisition times, make it unwieldy for broad-scale screening.

Image-processing software generated a synthetic 2D mammogram from the DBT data sets. A total of 3 Breast tomosynthesis state-of-the-art and review of the literature analyzed 8 CESM and FFDM measurements separately, considering the size of the residual tumor at its largest diameter and correlating it with that determined in the pathological analysis; inter-observer agreement was also evaluated.

These investigators summarized data on DBT screening in women with heterogeneously dense or extremely dense breasts, with the aim of estimating incremental additional BC detection attributed to DBT in comparison with standard 2D-mammography.

The main drawbacks of this study were: The authors concluded that the use of CAD is associated with reduced accuracy of interpretation of screening mammograms. Optimization with respect to the signal-to-quantum-noise ratio, commonly referred to as energy weighting, yielded only a minute improvement.

Bennett et al assessed current evidence to ascertain if the accuracy of single reading with CAD compares with that of double reading.

If these results were observed with screening cases, DBT and 2D mammography could benefit to the screening program by reducing the number of women recalled unnecessarily, especially if a synthetic 2D mammogram were used to minimize radiation exposure.

An assessment of CAD in mammography screening by the Swedish Council on Health Technology Assessment SBU, concluded that the scientific evidence is insufficient to determine whether CAD plus single reading by one breast radiologist would yield results that are at least equivalent to those obtained in standard practice, i.

Berg et al compared the diagnostic yield, defined as the proportion of women with positive screen test results and positive reference standard, and performance of screening with ultrasound plus mammography versus mammography alone in women at elevated risk of breast cancer.

Images of the entire breast can be captured regardless of tissue density. State-of-the-art conventional imaging resulted in needle biopsy of 45 breasts, of which 20 lesions were benign and a total of 25 cancers were diagnosed.

The DBT examinations were interpreted several weeks after the conventional imaging without knowledge of the conventional imaging findings. There exist several methods to acquire the images to be combined, which include dual energy subtraction using a single detection layer that suffers from motion artifacts due to patient motion between image acquisition.

Gilbert et al stated that digital breast tomosynthesis DBT is a 3D mammography technique with the potential to improve accuracy by improving differentiation between malignant and non-malignant lesions. Furthermore, an UpToDate review on "MRI of the breast and emerging technologies" Slanetz, states that "Emerging Imaging Technology for Breasr Cancer Detection -- Recognition of the limitations of mammography, ultrasound, and breast MRI has led to investigation of other breast imaging techniques including contrast-enhanced dual energy digital mammography, high-field strength MRI, magnetic resonance spectroscopy, diffusion weighted imaging, breast specific gamma imaging, and positron emission mammography".

The agreement between measurements was evaluated using Lin's coefficient. The AAFP and ACPM recommend that mammography in high-risk women begin at age 40, and AAFP recommends that all women aged 40 to 49 be counseled about the risks and benefits of mammography before making decisions about screening.

They then compared the performance of the 2 detectors under the variation of contrast agent concentration, tumor size and dose.

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The authors concluded that in this small data set, FFDM appears to be slightly more sensitive than digital breast tomosynthesis for the detection of calcification.

These researchers reported a high-resolution, low-dose phase contrast X-ray tomographic method for 3D diagnosis of human breast cancers.

Dense Breast Tissue: Supplemental Imaging

Seven of 10 cases were categorized as Breast Imaging Reporting and Data System score of 4 or higher by all four readers when reviewing spectral images in combination with mammograms.

In a later session, 3 radiologists performed a side-by-side feature analysis for cancer conspicuity in a sample of 50 cases.


The authors concluded that despite variations in the degree of tumor angiogenesis, quantitative analysis of the breast lesions on CESM documented the malignancies had distinctive stronger enhancement and depressed relative enhancement patterns than benign lesions.

Finally, readers were not totally blinded, because the laterality of the tumor was known to them.

Digital breast tomosynthesis (DBT): initial experience in a clinical setting

The small sample size precluded an analysis of diverse cancer types and the collection of data regarding the influence of molecular subtypes. The level of evidence was not greater than level II.

This might be useful in planning the extent of surgical excision. Given the large discrepancy in cancer detection rates for women with dense breast vs. Histopathology was taken as the gold standard. Skaane and colleagues compared DM and DBT in a side-by-side feature analysis for cancer conspicuity, and examined if there is a potential additional value of DBT to standard state-of-the-art conventional imaging work-up with respect to detection of additional malignancies.

These investigators examined the evidence on the accuracy of DBT in clinical studies. Since DBT acquisitions can now also be used to reconstruct high-definition 2D images, yielding similar BC detection as that from DBT plus 2D-mammography acquisitions, it seems reasonable that the next phase of DBT research and practice will increasingly adopt DBT-only acquisitions with reconstructed 2D images.

The authors concluded that the findings of this preliminary study suggested that it is possible to assess macroscopic borders of examined lesions on the basis of CESM imaging.

Data on women under age 50 are less clear. Based on tissue sampling results, 17 cases had breast cancer and 55 were benign.Baker JA & Lo JY. Breast Tomosynthesis: State-of-the-Art and Review of the Literature.

Acad Radiol – It is a promising technology which may be able to improve diagnostic accuracy in the early detection of breast cancer. A total of women underwent 2D digital mammography including supplementary cone-down and magnification views and breast ultrasonography if indicated, as well as digital breast tomosynthesis.

The indication for conventional imaging in the clinical setting included a palpable lump in 30 (23%), abnormal mammographic screening findings in. Literature Review: Digital Breast Tomosynthesis is organized by World Class CME and will be held during Nov 02, - Nov 01, This CME Conference has been approved for a maximum of 1 AMA PRA Category 1 Credits.

Conference Objectives are: • Review the main literature published on the benefits and effectiveness of Breast. This article will review the current literature and develop an evidence-based approach to supplemental imaging for women with dense breast tissue by concentrating on two U.S.

Food and Drug Administration (FDA)-approved supplemental techniques, digital breast tomosynthesis (DBT) and automated breast ultrasound (ABUS).

GUIDELINE DEVELOPMENT. The ACS convened an expert panel to review the existing early detection guideline for women at increased risk and for MRI screening based on evidence that has accumulated since the last revision in to World Class CME is a physician-founded company focused on providing outstanding continuing medical education in the areas of radiology, breast imaging, ob-gyn ultrasound, gynecology and sleep medicine.

State of the Art Literature Review: All You Need to Know

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Breast tomosynthesis state-of-the-art and review of the literature
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