Summary: | Purpose To evaluate the diagnostic performance of digital breast tomosynthesis (DBT) with the two-dimensional synthesized mammogram (2DSM), compared to full-field digital mammography (FFDM),
for suspicious microcalcifications in the breast ahead of stereotactic biopsy and to assess the diagnostic
image visibility of the images.
Materials and Methods This retrospective study involved 189 patients with microcalcifications,
which were histopathologically verified by stereotactic breast biopsy, who underwent DBT with 2DSM
and FFDM between January 8, 2015, and January 20, 2020. Two radiologists assessed all cases of microcalcifications
based on Breast Imaging Reporting and Data System (BI-RADS) independently. They
were blinded to the histopathologic outcome and additionally evaluated lesion visibility using a fivepoint
scoring scale.
Results Overall, the inter-observer agreement was excellent (0.9559). Under the setting of category
4A as negative due to the low possibility of malignancy and to avoid the dilution of malignancy criteria
in our study, McNemar tests confirmed no significant difference between the performances of the
two modalities in detecting microcalcifications with a high potential for malignancy (4B, 4C, or 5; p =
0.1573); however, the tests showed a significant difference between their performances in detecting
microcalcifications with a high potential for benignancy (4A; p = 0.0009). DBT with 2DSM demonstrated
superior visibility and diagnostic performance than FFDM in dense breasts.
Conclusion DBT with 2DSM is superior to FFDM in terms of total diagnostic accuracy and lesion visibility
for benign microcalcifications in dense breasts. This study suggests a promising role for DBT
with 2DSM as an accommodating tool for stereotactic biopsy in female with dense breasts and suspicious
breast microcalcifications.
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