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Invasive ductal carcinoma in a 45-year-old woman with a lump in the left breast for 6 months. (a) Digital mammogram clearly shows an oval-shaped relatively wellcircumscribed primary mass. (b) Breast tomosynthesis image provides better depiction of the microlobulated, spiculated border of the mass (arrows ), a finding suggestive of malignancy. (See also Movie 6 at radiographics.rsnajnls.org/cgi /content/full/27/S231/DC1.)
Source publication
Mammography is an effective imaging tool for detecting breast cancer at an early stage and is the only screening modality proved to reduce mortality from breast cancer. However, the overlap of tissues depicted on mammograms may create significant obstacles to the detection and diagnosis of abnormalities. Diagnostic testing initiated because of a qu...
Context in source publication
Context 1
... our experience with breast cancer cases, the border of the main mass, any adjacent architec- tural distortion, and the extent of accompanying microcalcifications are better depicted on breast tomosynthesis images than on mammograms (Figs 5-8). Tomosynthesis also provides more accurate 3D localization of the tumor for surgical planning. ...
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To assess the acceptability of new non-invasive breast cancer diagnostic tests intended to triage women in need of biopsy.
Women who had abnormal screening tests and had been recommended to have a biopsy were invited to receive digital mammography, magnetic resonance imaging (MRI), and nuclear medicine evaluation (Tc-99m-sestamibi scanning) before...
Citations
... DBT allows volumetric reconstruction of the entire breast from several two-dimensional projections obtained using different X-ray tube angles [8]. The cancer detection sensitivity in DBT has been shown to be higher than that in conventional FFDM because it reduced breast tissue overlap and provides better visualization of lesions [9,10]. Therefore, DBT is better than conventional FFDM for assessing the morphological features of tumors [11]. ...
To develop a deep learning (DL)-based algorithm to predict the presence of stromal invasion in breast cancer using digital breast tomosynthesis (DBT). Our institutional review board approved this retrospective study and waived the requirement for informed consent from the patients. Initially, 499 patients (mean age 50.5 years, age range, 29-90 years) who were referred to our hospital under the suspicion of breast cancer and who underwent DBT between March 1 and August 31, 2019, were enrolled in this study. Among the 499 patients, 140 who underwent surgery after being diagnosed with breast cancer were selected for the analysis. Based on the pathological reports, the 140 patients were classified into two groups: those with non-invasive cancer (n = 20) and those with invasive cancer (n = 120). VGG16, Resnet50, DenseNet121, and Xception architectures were used as DL models to differentiate non-invasive from invasive cancer. The diagnostic performance of the DL models was assessed based on the area under the receiver operating characteristic curve (AUC). The AUC for the four models were 0.56 [95% confidence intervals (95% CI) 0.49-0.62], 0.67 (95% CI 0.62-0.74), 0.71 (95% CI 0.65-0.75), and 0.75 (95% CI 0.69-0.81), respectively. Our proposed DL model trained on DBT images is useful for predicting the presence of stromal invasion in breast cancer.
... Units that are now developed for clinical use have dual functionality; that is, both two-dimensional (2D) digital mammography and breast tomosynthesis may be performed with the same unit. Hence breast tomosynthesis has the advantages of digital mammography, such as reproducibility and can eliminate the problem of overlapping structures in the breast as well thereby enhancing margin visibility [8]. ...
Background
Mammography is the primary imaging modality for diagnosing breast cancer in women more than 40 years of age. Digital breast tomosynthesis (DBT), when supplemented with digital mammography (DM), is useful for increasing the sensitivity and improving BIRADS characterization by removing the overlapping effect. Ultrasonography (US), when combined with the above combination, further increases the sensitivity and diagnostic confidence. Since most of the research regarding tomosynthesis has been in screening settings, we wanted to quantify its role in diagnostic mammography. The purpose of this study was to assess the performance of DM alone vs. DM combined with DBT vs. DM plus DBT and ultrasound in diagnosing malignant breast neoplasms with the gold standard being histopathology or cytology.
Results
A prospective study of 1228 breasts undergoing diagnostic or screening mammograms was undertaken at our institute. Patients underwent 2 views DM, single view DBT and US. BIRADS category was updated after each step. Final categorization was made with all three modalities combined and pathological correlation was done for those cases in which suspicious findings were detected, i.e. 256 cases. Diagnosis based on pathology was done for 256 cases out of which 193 (75.4%) were malignant and the rest 63 (24.6%) were benign. The diagnostic accuracy of DM alone was 81.1%. Sensitivity, Specificity, PPV and NPV were 87.8%, 60%, 81.3% and 61.1%, respectively. With DM + DBT the diagnostic accuracy was 84.8%. Sensitivity, Specificity, PPV and NPV were 92%, 56.5%, 89% and 65%, respectively. The diagnostic accuracy of DM + DBT + US was found to be 85.1% and Sensitivity, Specificity, PPV and NPV were 96.3%, 50.7%, 85.7% and 82%, respectively.
Conclusion
The combination of DBT to DM led to higher diagnostic accuracy, sensitivity and PPV. The addition of US to DM and DBT further increased the sensitivity and diagnostic accuracy and significantly increased the NPV even in diagnostic mammograms and should be introduced in routine practice for characterizing breast neoplasms.
... The accurate classi cation of BI-RADS 4A lesions could reduce unnecessary biopsies [7]. Despite the potential advantages of DBT, this technology has some limitations,some studies reported that DBT alone has a lower sensitivity in detecting and characterizing pure calci cations compared to DM [8,9].The use of DBT in the diagnosis of calci cations remains ambiguous [8][9][10][11][12]..Therefore the study aimed to evaluate the role of DBT in the differential diagnosis of non-calci ed BI-RADS 4A lesions identi ed on DM. The clinical factors such as age and breast density that may increase the risk of malignancy of the BI-RADS 4A lesions were also evaluated. ...
Background: The study aimed to evaluate the role of digital breast tomosynthesis (DBT) in the differential diagnosis of digital mammography (DM) lesions classified as 4A according to the Breast Imaging Reporting and Data System (BI-RADS).
Methods: The DM and DBT of patients diagnosed with non-calcified BI-RADS 4A lesions at our institution between January 2019 and August 2020 were analyzed retrospectively. The BI-RADS 4A lesions on DM were downgraded to BI-RADS 3 if the lesion on DBT was more visible than on the mammogram and more than 50% of its boundary was sharp without suspicious signs of malignancy. Conversely, the lesions were upgraded to BI-RADS 4B and 4C if they presented with an irregular shape or showed non-circumscribed margins on DBT. The Mann-Whitney U test was used to compare the categorical variables, and the T-test was used to analyze the continuous variables between the benign and malignant pathologically confirmed cases.
Results: A total of 191 lesions were evaluated, of which 129 were confirmed to be benign on pathology examination, and the rest were malignant.After plus DBT,25.1% of lesions showed lesion type change which was asymmetry on DM but presented mass or architectural distortion on DBT, and 46.3 % of the asymmetric DM lesions were seen as a uniform mass on DBT. DBT showed superior or equal visualization to DM for circumscribed masses. Most (97.2%) of the circumscribed masses on DBT were confirmed benign on pathology, while 91.7% of the non-circumscribed were confirmed to be malignant on pathology. After plus DBT,61.8% of the lesions had BI-RADS change, for the lesions downgraded to BI-RADS 3 on DBT, there were 54.3% confirmed to be benign on pathology, while 64.5% of upgraded to BI-RADS 4B or 4C lesions were malignant on pathology.
Conclusion: DBT can be used to facilitate the discrimination of benign and malignant BI-RADS 4A lesions on DM and hence reduce the need for unnecessary biopsies.
... [1][2][3][4][5][6][7] Indeed, national guidelines recommend routine breast MRI screening in women with an elevated lifetime breast cancer risk of 20% or more. 8 Thus, even with pressures from healthcare cost containment, the emergence of X-ray tomographic systems [9][10][11][12][13][14] and the expense of an exam, the number of breast MRI studies is growing because of their exquisite softtissue contrast. However, DCE-MRI causes many false positives 15,16 due to reliance on gadolinium (Gd) as a nonspecific contrast agent. ...
... These findings are troubling because of the clinical management burden created by the increase in contrast-enhancing foci that need to be evaluated. Further, Gd-based contrast agents are not universally well tolerated because of risk of adverse reactions, 9 and contraindications in patients with impaired renal function. 10 The U.S. Food and Drug Administration (FDA) has noted that higher than recommended or repeat doses of Gd appear to increase risk for nephrogenic systemic fibrosis in those who have kidney disease 11 In addition, reports indicate mounting concern over Gd found in deep brain nuclei after systemic injection. ...
Purpose
We have developed a fully 3D data acquisition system for microwave breast imaging which can operate simultaneously inside a magnetic resonance imaging (MRI). MRI is used regularly for breast imaging to distinguish tumors from normal tissue. It generally has poor specificity unless used with a gadolinium contrast agent. Microwave imaging could fill this need because of the good endogenous tumor:normal tissue property contrast, especially in light of safety concerns for gadolinium. The antenna array consists of 16 monopole antennas positioned in a horizontal circle surrounding the breast which can then be moved vertically for 3D coverage of the breast. The tank system materials were chosen to minimize artifacts in the MR image within the specific shared imaging zone. The support rods are stainless steel, albeit positioned sufficiently far from the imaging target to have little effect. The mechanical motion parts are all 3D printed plastic. Unlike many conventional antennas, the monopoles consist of just the center conductor and insulator of the coaxial cable, making it one of the least possible metallic structures.
Methods
Data were acquired both inside and outside of the MR bore to confirm that the MR bore did not have adverse effects on the microwave imaging process. The imaging tank was filled with a mixture of glycerin and water to both provide a reasonable property match to the phantom and to highly attenuate the fields which also acted to suppress multi‐path signals. Microwave images were reconstructed using our Gauss–Newton scheme combined with a log transformation for a more linear convergence. MR images were also acquired to assess the effects of the microwave tank structures on the imaging.
Results
The microwave measurement data were acquired in log magnitude and phase format at 200 MHz increments from 700–1900 MHz. Each antenna acted sequentially as a transmitter while the complement of 15 acted as a receiver. The single frequency images were reconstructed using a Gauss–Newton iterative technique with a standard log transformation to linearize the process. The data showed that the signal strengths were between 7–10 dB lower for the case when the array was inside the MRI versus when not. Notwithstanding, the image quality was still high because of the significant signal to noise ratio. The reconstructed images in both situations demonstrated good 3D object recovery of the vertically size and shaped varying object. The MR images were not adversely affected by the presence of antennas or feed structures.
Conclusions
We have demonstrated that our technique can recover high‐quality images of a 3D varying object within an MRI system. Compatibility issues have been addressed for both the microwave and MRI systems. The reduced SNR for the case operating in the MRI did not adversely affect the images. To the best of our knowledge, this is the first example of a microwave imaging system operating in an MRI with full 3D volumetric capability.
... DBT allows a volumetric reconstruction of the whole breast from several two-dimensional projections obtained by different X-ray tube angles [8]. The cancer detection sensitivity in DBT has been shown to be higher than conventional FFDM because breast tissue overlap is reduced and lesions are better visualized [9,10]. Therefore, DBT is better than conventional FFDM to assess morphological features of the tumor [11]. ...
Purpose:
To develop a deep learning (DL)-based algorithm to predict the presence of stromal invasion of breast cancer on digital breast tomosynthesis (DBT).
Materials and Methods:
The institutional review board approved this retrospective study and waived the requisite to obtain the informed consent from the patients. Initially, 499 patients (mean age of 50.5 years, ranging from 29 to 90 years) who were referred to our hospital suggestive of breast cancer and performed DBT between March 1, 2019 and August 31, 2019, were enrolled in this study. Out of the 499 patients, 140 patients who were performed surgery with diagnosed breast cancer were finally selected. Based on the pathological reports, 140 patients were divided to be categorized as 20 patients with non-invasive cancer and 120 patients with invasive cancer. Xception architecture was used for the DL model to differentiate non-invasive cancer and invasive cancer. Diagnostic performance of the DL model was assessed by accuracy, sensitivity, specificity, and areas under the receiver operating characteristic curve (AUC).
Results:
The average accuracy, sensitivity, specificity, and AUC were 0.897, 0.909, 0.758, and 0.749, respectively.
Conclusion:
The proposed DL model trained on DBT images is useful to predict the presence of stromal invasion of breast cancer.
Secondary abstract
The proposed deep learning (DL) model trained on digital breast tomosynthesis (DBT) images is useful to predict the presence of stromal invasion of breast cancer.
... Esta herramienta se usa modificando la tecnología de una unidad mamográfica. Se usan un número de proyecciones y con estas imágenes se reconstruye un modelo en 3D con algoritmos parecidos a la tomografía computarizada [6]. En la figura 1 se puede observar una unidad de tomosintesis utilizada en el departamento de Radiología de la Universidad de Iowa, en la imagen se puede observar como rota la unidad para tomar imágenes en diferentesángulos. ...
... Luego en (c,d) es la reconstrucción de las imágenes 3D por medio de proyecciones convencionales. Tomada de [6] anteriores se cumplen los requisitos de Colegio Americano de Radiologia [8].Algunos de estos criterios son: mejores tasas de detección de cáncer y menos llamada a pacientes para pruebas adicionales . Además, el total de la radiación es igual o menor al de una mamografía convencional y se obtiene una mejor visibilidad de los objetos o tumores para poder delimitar bien los bordes [9]. ...
... Fotografía de una unidad de tomosíntesis del departamento de Radiología de la Universidad de Lowa, donde (a) está a -7.5 • y (b) esta a 7.5 • . Tomada de[6] ...
La tomos´ıntesis de seno es una forma avanzada de mamograf´ıa. Se basa en un tipo espec´ıfico de toma de imagenes ´
del seno que utiliza dosis bajas de rayos X para detectar el cancer en forma temprana. En las im ´ agenes se detectan ´
microcalcificaciones; en las cuales gracias a la tomos´ıntesis podremos medir caracter´ısticas como la profundidad,
la morfologia, entre otras que en una mamograf´ıa convencional no son posibles. Este tipo de tecnica es importante ´
debido a que se puede detectar el cancer de manera m ´ as temprana lo que resulta en que el c ´ ancer sea m ´ as tratable. ´
Esta tecnica consiste en realizar proyecciones a diferentes ´ angulos con una fuente de rayos x hacia un fantoma. Sin ´
embargo, el numero y la amplitud de los ´ angulos no se ha establecido de una forma general. Por esta raz ´ on, en esta ´
investigacion se calcul ´ o el n ´ umero y la amplitud de estos ´ angulos para optimizar el c ´ alculo de la profundidad en las ´
microcalcificaciones. En el grupo de la universidad no se han hecho estos estudios de montecarlo con el simulador
GATE. Para este metodo se aprendi ´ o a usar GATE comenzando desde simulaciones sencillas hasta los datos del ´
laboratorio, con estas simulaciones se obtuvo la tomosintesis para diferentes angulos y numero de proyecciones ´
computacional. Ademas, se verific ´ o la reconstrucci ´ on 3D con los datos obtenidos el laboratorio de altas energ ´ ´ıas
... 19 Recently, digital breast tomosynthesis (DBT) was developed and has sparked increased interest in clinical settings due to its higher sensitivity for breast cancer detection compared to other imaging methods. [20][21][22][23] One of the main issues with FFDM is that it causes obscuring of tumor outline due to overlying surrounding breast tissue; DBT overcomes this major problem. 24 However, few studies have assessed the diagnostic performance of DBT in preoperative staging after NST in comparison to traditional imaging methods such as FFDM, US, or MRI. ...
... DBT shows higher detection rate and diagnostic accuracy for both benign and malignant mass-like lesions, with better sensitivity and specificity and lower recall rates. [20][21][22][23] However, there are few studies on the usefulness of DBT in assessment of breast cancer after NST. 24,25 DBT has been reported to improve diagnostic accuracy after NST and the combination of DBT and other imaging modalities was shown to provide more accurate assessment of response to NST. 24 Park et al. reported that DBT and MRI better correlated with pathology than that on mammography and US. 25 These results are consistent with the findings of our study. ...
Background
The goals of neoadjuvant systemic therapy (NST) are to reduce tumor volume and to provide a prognostic indicator in assessing treatment response. Digital breast tomosynthesis (DBT) was developed and has increased interest in clinical settings due to its higher sensitivity for breast cancer detection compared to full-field digital mammography (FFDM).
Purpose
To evaluate the accuracy of DBT in assessing response to NST compared to FFDM, ultrasound (US), and magnetic resonance imaging (MRI) in breast cancer patients.
Material and Methods
In this retrospective study, 95 stages II–III breast cancer patients undergoing NST and subsequent surgeries were enrolled. After NST, the longest diameter of residual tumor measured by DBT, FFDM, US, and MRI was compared with pathology. Agreements and correlations of tumor size were assessed, and the diagnostic performance for predicting pathologic complete response (pCR) was evaluated.
Results
Mean residual tumor size after NST was 19.9 mm for DBT, 18.7 mm for FFDM, 16.0 mm for US, and 18.4 mm for MRI, compared with 17.9 mm on pathology. DBT and MRI correlated better with pathology than that of FFDM and US. The ICC values were 0.85, 0.87, 0.74, and 0.77, respectively. Twenty-five patients (26.3%) achieved pCR after NST. For predicting pCR, area under the receiver operating characteristic (ROC) curve for DBT, FFDM, US, and MRI were 0.79, 0.66, 0.68, and 0.77, respectively.
Conclusion
DBT has good correlation with histopathology for measuring residual tumor size after NST. DBT was comparable to MRI in assessing tumor response after completion of NST.
... Since 2011, tomosynthesis has been applied in the 3D breast imaging [2]. Compared with traditional two-dimensional (2D) radiography, tomosynthesis avoids the superpositions of tissues at different depths, and can thus be applied to detect potential lung cancer nodes and breast cancer lesions [3][4][5][6][7]. A typical tomosynthesis system consists of a poly-energetic X-ray source and an energy integrating detector, which sums up the attenuation information of the object over the entire spectrum. ...
Compressive spectral X-ray imaging (CSXI) introduces a pixelated spectral modulator called K-edge coded aperture (KCA) in front of the X-ray source, which enables both, lower dosage to the subject, as well as the capability of spectral tomography while using low-cost integrating X-ray detectors. CSXI systems generally use hundreds of different spectral modulators, each with a distinct pattern to uniquely modulate the illumination at every view angle. In contrast, this paper introduces the use of a single and static coded aperture placed in a tomosynthesis gantry. The compressive system thus interrogates the subject with a fixed coded illumination pattern on all view angles. The advantages of the system are many including reduced cost and the feasibility of implementation. Given the reduced set of coded measurement and the limited spectral separation ability in the resulting architecture, the nonlinear inverse reconstruction problem results in a highly ill-posed problem. An efficient alternating minimization method with three-dimensional total variation regularization is developed for image reconstruction. Furthermore, rather than simply using a random pattern, the coded aperture is optimized under a uniform sensing criterion that shapes the spatial and spectral pattern of the coded aperture so as to minimize the overall radiation exposure placed on any volumetric area of the patient. This is of particular importance in medical imaging where patients at risk are recommended to have periodical X-ray tomosynthesis screenings. The coded aperture optimization is then posed as a binary programming problem solved by a gradient-based algorithm with equilibrium constraints. Numerical experiments show that spatial and spectral coding used in the proposed system to interrogate the subject not only reduces the radiation dose but it also improves the quality of image reconstruction. Gains close to 5dB in peak signal to noise ratio are observed in simulations. Furthermore, it is shown that the optimization of the KCA can effectively improve the uniformity of X-ray radiation compared to random KCA modulation, thus reducing the radiation dose throughout all volumetric sub-areas of the subject — an objective that is not possible with the use of random KCAs.
... [1] Strategies for detecting them on screening mammograms include symmetrical comparison of breasts, looking for distortions in parenchymal contour, observation of the retro mammary fat, associated findings, and comparison with previous mammographic studies. [2] The perception of these findings is crucial to get them diagnosed and treated effectively. Missing or miss-interpreting them can be due to limitations of the diagnostic equipment, fatigue of radiologists during screening programs, or the indistinct features of tumors as they appear on mammography [3]. ...
Introduction: Mammography is the most used breast screening tool and was proven to reduce breast-cancer-associated mortality. The estimated sensitivity of mammography varies between 77% and 95%; however, sensitivity could be 26% lower in dense breasts than in entirely fatty breasts. The ability to represent the complex 3D breast architecture and early changes in anatomical structures in a 2D view is the biggest challenge for mammography. In Digital Breast Tomosynthesis (DBT), tomographic images are reconstructed from multiple projections acquired from different angles. This technique allows the generation of 3D data, reduction of tissue overlap and allows better evaluation of masses, architectural distortion, and asymmetries compared with conventional two-dimensional mammographic images.
Objective: To evaluate the impact of Digital Breast Tomosynthesis on BIRADS categorization of mammographic non-mass findings.
Methods: Prospective cohort for 180 women with mammographic non-mass findings who presented to Alexandria University Radio diagnosis Department either for screening or diagnostic purposes between July 2019 and August 2020 with mean age 51.44 ± 10.67 . Digital breast tomosynthesis and ultrasound was done for all patients. Lesions were evaluated on DM; DBT alone then combined DBT & DM. Comparison of results according to changes in BIRADS, diagnostic performance using histopathology as gold standard.
Results: 208 non-mass findings were detected by conventional mammography (104 asymmetry, 35 architectural distortion, 69 micro calcifications), Tomosynthesis reduced the BIRADS 3 count by 32%, upgraded the count of BIRADS 4 lesions by 11.4% while upgraded the BIRADS 2 by 18.9% with consequent improvement of sensitivity and specificity, PPV, NPV and accuracy to 96%, 95%, 94%,97%, and 95.6%.
Conclusion: Combined FFDM and DBT improved the diagnostic performance in evaluation of non-mass findings and proper BIRADS categorization.
... In order to improve the diagnostic performance of x-ray-based methods, digital breast tomosynthesis (DBT) is increasingly being applied either in addition to or as a replacement for breast cancer screening. The 3-dimensional mammographic imaging in DBT offers increased cancer detection rates and reduced false-positive findings [5,6]. ...
Background:
Digital breast tomosynthesis (DBT) and abbreviated breast MRI (AB-MRI) offer superior diagnostic performance compared to conventional mammography in screening women with intermediate risk of breast cancer due to dense breast tissue. The aim of this model-based economic evaluation was to analyze whether AB-MRI is cost-effective in this cohort compared to DBT.
Methods:
Decision analysis and Markov simulations were used to model the cumulative costs and quality-adjusted life-years (QALYs) over a time horizon of 30 years. Model input parameters were adopted from recent literature. Deterministic and probabilistic sensitivity analyses were applied to test the stability of the model.
Results:
In the base-case scenario, the costs of an AB-MRI examination were defined to equal the costs of a full protocol acquisition. Two-yearly screening of women with dense breasts resulted in cumulative discounted costs of $8798 and $9505 for DBT and AB-MRI, and cumulative discounted effects of 19.23 and 19.27 QALYs, respectively, with an incremental cost-effectiveness ratio of $20,807 per QALY gained in the base-case scenario. By reducing the cost of an AB-MRI examination below a threshold of $241 in sensitivity analyses, AB-MRI would become cost-saving compared to DBT.
Conclusion:
In comparison to DBT, AB-MRI can be considered cost-effective up to a price per examination of $593 in screening patients at intermediate risk of breast cancer.
