3D Tomosynthesis Might Reduce False-positive Breast Biopsy Rates

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(ChemotherapyAdvisor)–Digital breast tomosynthesis (3-dimensional) mammography outperforms supplemental 2D mammography views for the accurate classification of masses and distortions, according to a study published in the journal Radiology.

“Tomosynthesis significantly improved diagnostic accuracy for noncalcified lesions compared with supplemental mammographic views,” reported Margarita L. Zuley, MD, of the Department of Radiology at the University of Pittsburgh Medical Center's Magee-Womens Hospital, and coauthors. “Our results suggest that practice patterns may be altered to allow for the replacement of conventional supplemental views with tomosynthesis images for assessment of these findings.”

With digital breast tomosynthesis the x-ray tube moves along an arc, capturing low-radiation-dose images that can be reconstructed into 3D depictions of “masses, areas of architectural distortion, and asymmetries,” the authors wrote.

Overlying tissues that can disrupt conventional 2D mammographic visualization of lesion margins and contours are not within the plane of focus in tomosynthesis-based images, the authors explained.  That means tomosynthesis might more sensitively detect small lesions that would be “obscured by superimposed dense tissue” in conventional 2D mammograms, they wrote.

When tomosynthesis was used, “the false-positive rate decreased from 85% (989 of 1160) to 74% (864 of 1160) (P<0.01) for cases that were rated BI-RADS (Breast Imaging Reporting and Data System) category 3 or higher and from 57% (663 of 1160) to 48% (559 to 1160) for cases rated BI-RADS category 4 or 5 (P<0.01), without meaningful change in sensitivity,” the authors reported.

“It is possible that tomosynthesis may reduce the need for extra views and even ultrasonography (US) in some cases,” the authors wrote. “Even more important, tomosynthesis may reduce the rate of false-positive breast biopsies. Several studies have shown that tomosynthesis is subjectively preferred to conventional mammography, and it may offer superior diagnostic accuracy for the evaluation of breast lesions.”

Abstract

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