Digital breast tomosynthesis and breast ultrasound: Additional roles in dense breasts with category 0 at conventional digital mammography.
OBJECTIVE
To compare the diagnostic performances of digital breast tomosynthesis (DBT) and ultrasound for the dense breasts with category 0 at conventional digital mammography.


METHODS
This retrospective study was approved by the institutional review board, and informed consent was waived. Among the 1103 patients who underwent screening digital mammography at our institution, 769 (69.7%) patients had dense breasts. Of the 769 patients, 229 (29.8%) lesions were categorized as 0. DBT, breast ultrasound and digital mammography were performed in 108 (47.2%) patients. BI-RADS final assessments for DBT and ultrasound were recorded. Categories 1-3 were clinically considered as benign, and categories 4 and 5 were clinically considered as malignant. The diagnostic performances of breast ultrasound and DBT were correlated with final pathologic reports or follow-up images.


RESULTS
Among 108 lesions, 17 (15.7%) were malignant and 91 (84.3%) were benign. Sensitivity was 100% for both ultrasound (17/17) and DBT (17/17) and negative predictive value was also 100% for both ultrasound (49/49) and DBT (74/74). Specificity and positive predictive value for ultrasound were 53.9% (49/91) and 28.8% (17/59), respectively. Specificity and positive predictive value for DBT were 81.3% (74/91) and 50% (17/34), respectively. DBT showed higher diagnostic accuracy than that of breast ultrasound (DBT: 84.3%, 91/108; ultrasound: 61.1%, 66/108; p<0.001). The benign biopsy rate of DBT (50%, 17/34) was lower than that of ultrasound (71.2%, 42/59).


CONCLUSIONS
DBT showed better diagnostic performance than breast ultrasound for dense breasts with category 0. DBT may reduce the benign biopsy rate and short term follow-up.
Department of Radiology, Ewha Womans University, School of Medicine, Seoul, South Korea.
Won Kyung
WK
Lee
Department of Radiology, Ewha Womans University, School of Medicine, Seoul, South Korea. Electronic address: aqua0724@ewha.ac.kr.
Jin
J
Chung
Department of Radiology, Ewha Womans University, School of Medicine, Seoul, South Korea.
Eun-Suk
ES
Cha
Department of Radiology, Ewha Womans University, School of Medicine, Seoul, South Korea.
Jee Eun
JE
Lee
Department of Radiology, Ewha Womans University, School of Medicine, Seoul, South Korea.
Jeoung Hyun
JH
Kim
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000379:methods*
Breast; Dense breast; Digital breast tomosynthesis; Digital mammography; Ultrasound