Poster No.: C-1905, ECR 2014

AUTHORS : Natasa Prvulovic Bunovic, Mladen Prvulovic, Dragana Djilas-Ivanovic, Katarina Koprivsek

Keywords: Breast, Mammography, Diagnostic procedure, Technical aspects, Neoplasia

Aims and objectives

According to the recommendations of the American College of Radiology (ACR) we accepted BIRADS (Breast Imaging Reporting and Data System) as a quality assurance tooland standardized mammography reports. Each lesion was classified according to BI RADS descriptors for masses (margins and shape) and calcifications (morphology and distribution) and was categorized by the BI RADS final assessment categories (numeric value 0-6). All breast findings should be differentiated in terms of benign or malignant, and the final impression needs to clearly state the degree of suspicion for malignancy and offer recommendations for further management based on the BI RADS classification. In BI RADS 3 category which is „probably benign“ we classified breast changes or lesions with a probability of benign nature in 98 percent or more and all these cases were followed up by mammography at 6 months period. Mammography is the primary imaging modality in the evaluation of breast lesions, especially cancers. In the detection and characterisation of benign masses it usually required additional mammographic views or further research by other imaging modality. Tomosynthesis (TS) is new diagnostic techniques in breast evaluations with a promising role in rising sensitivity and specificity of digital mammography (DM). The purpose of this study was to assessed the diagnostic significance of tomosynthesis after digital mammography detected BIRADS 3 lesions.

Methods and materials

The study was prospective and conducted at Oncology Institute, Department of Diagnostic Imaging at Sremska Kamenica, Serbia, between March 2009 to August 2013. We performed TS in 360 DM detected BIRADS3 lesions. We evaluated breasts during screening and after diagnostic exam on the Hologic Selenia Dimensions system. The radiologist independently reads DM and TS. As a part of the diagnostic procedure, after the mammography examination, in some patients core biopsy under ultrasound or stereotactic biopsies were performed. Most patients were followed up over a period of 2 or more years. All mammograms were classified as BIRADS1-5 category after TS.

Are shown in TABLE 1 and 2. Only 22.8% of BIRADS3 lesions (82/360) did not change within the category after TS. After TS, 77.2% (278/360) digital mammography noticed lesions were re-classified according to the BIRADS system. TS „downstaged“ to BIRADS1 or 2 category the majority of cases (263/360) and „upstaged“ 15 cases to BIRADS4 and 5. At the follow-up studies two-thirds of the DM detected BIRADS 3 lesions were „downstage“ to BIRADS 1, 2 or stay in BIRADS 3 category and were stable in at least during the 2 year period. We performed a biopsy in all suspected findings on Tomosynthesis. TS detected 6 cancers in 9 lesions BIRADS4 category and in all 6 lesions classified into BIRADS 5.



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Our results indicated that TS in BIRADS 3 category were performed after DM „downstage“ in two-thirds of cases. It significantly reduced the need for additional mammographic views and frequent follow up studies. TS did not show any falsenegative results in this study and it did not miss any cancers. In addition, reduction of numerous mammographic controls examination reduces the stress levels in women. Therefore, Tomosynthesis should be applied in the diagnostic algorithm in patients with mammography detected BIRADS3 lesions.



Fig. 1: Case 1 DM L CC Mass in the upper outer quadrant of the left breast, BI RADS 3 on DM, BI RADS 5 on TS



Fig. 2: Case 1 DM L MLO Mass in the upper outer quadrant of the left breast,  BI RADS 3 on DM, BI RADS 5 on TS



Fig. 3: Case 1 TS L CC Mass in the upper outer quadrant of the left breast, BI RADS 3 on DM, BI RADS 5 on TS



Fig. 4: Case 1 DM L MLO Mass in the upper outer quadrant of the left breast, BI RADS 3 on DM, BI RADS 5 on TS