Correlation between lesion type and the additional value of digital breast tomosynthesis

Transcription

1 Correlation between lesion type and the additional value of digital breast tomosynthesis Poster No.: C-1604 Congress: ECR 2011 Type: Scientific Exhibit Authors: C. Van Ongeval, L. Cockmartin, A. Van Steen, S. Postema, H. Bosmans; Leuven/BE Keywords: Breast DOI: /ecr2011/C-1604 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 14

2 Purpose To evaluate the feasibility of digital breast tomosynthesis (DBT) for detection and diagnosis of breast pathologies in comparison to 2D-digital-mammography (2D). We report our clinical findings on the correlation between the breast lesion types and the additional value of DBT. Page 2 of 14

3 Methods and Materials In 2009, breast tomosynthesis was introduced in our department. Our preliminary clinical results will be outlined here. The study includes women referred with an abnormal screening mammogram, with clinical symptoms, or referred from other hospitals for second opinion. They underwent a 2D mammography and were asked to participate in the study. After mammography, further work-up was done with ultrasound and if necessary, fine needle aspiration cytology or core biopsy. In some cases a MRI was acquired during further work-up of proven malignancy. After standard 2D digital imaging, breast tomosynthesis acquisitions were performed with a Siemens Mammomat Inspiration Tomo system (Siemens, Erlangen, Germany): 78 women underwent a DBT examination of the left breast, 60 of the right breast and 12 women received a DBT of both breasts. Our tomosynthesis images database consists of 58 single MLO projections, 2 single CC projections and 90 breast images in both CC and MLO view. Page 3 of 14

4 Images for this section: Fig. 0: Fig. 7a. 45y old woman came for yearly control (mammography, ultrasound and magnetic resonance imaging) after a previous history of breast cancer on the left breast (mastectomy with reconstruction). A new irrular enhancing mass was discovered and biopsied. After the biopsy, a tomosynthesis was done in order to see if tomosynthesis could show this small lesion in a dens breast. Page 4 of 14

5 Fig. 0: Fig 7b. Corresponding slices of the tomosynthesis set of images of the right breast (fig 7a). In the inferior part of the breast, small air bubles locate the place of the lesion, where a small distortion could be recognized. Page 5 of 14

6 Results The study includes 150 women with an average age of 59 years. Histopathological proof and further clinical follow-up showed 16 benign cases (10.5%), 113 malignant lesions (75%) and no abnormalities in 23 cases (14.5%). DBT examinations of two patients could not be used for technical reasons. A total of 159 lesions were evaluated: preliminary reports suggest that for the stellate lesions in 32 cases DBT provided more information than 2D digital mammography, in 9 cases the two techniques provided similar information and for 3 cases, DBT was worse compared to 2D mammography. For opacities, DBT was better in 45 cases, similar in 31 cases and worse in 13 cases. For clusters of microcalcifications, DBT was better in 4 cases, similar in 8 cases and worse in 14 cases (Table). Information on 3D Better than 2D Similar to 2D Worse than 2D 9 (20.4%) 3 (6.8%) 45 (50.5%) 31 (34.8%) 13 (14.6%) 4 (11.1%) 8 (22.2%) 14 (38.8%) Stellate lesions ( n= 32 ( 72.7%) 44 cases) Opacities (n= 89 cases) Microcalcifications (n= 36 cases) Comparison of 3D imaging with the information on 2D imaging for different lesion types Page 6 of 14

7 Images for this section: Fig. 0: Fig.1a. Screening mammogram, oblique view of the right breast shows a suspicious lesion in the cranial part of the breast,which is difficult to delineate on the 2D image (a). On the corresponding slice of the tomosynthesis set of images however, the stellate lesion is much better visible. Page 7 of 14

8 Fig. 0: Fig. 1b. Screening mammogram, craniocaudal view of the right breast shows a discrete stellate lesion in the central part of the breast (a). On the corresponding slice of the tomosynthesis set of images the stellate lesion is much better visible. Histology showed a radial scar lesion. Page 8 of 14

9 Fig. 0: Fig. 2. Screening mammogram. The 2D image on the left side shows multiple irregular opacities. On the 2 corresponding slices of the tomosynthesis set of images the borders of the opacities can be better delineated: they show more benign caracteristics. On ultrasound and cytology the opacities correlate with benigne cysts. Fig. 0: Fig. 3. Screening mammogram. On the oblique view of the right breast an irregular density in het upper part of the breast was recognized on the 2D image (left side). On the corresponding slice of the tomosynthesis set of images the irregular borders and spiculations can be better recognized. Histology shows a moderately differentiated invasive ductal carcinoma of 2cm. Page 9 of 14

10 Fig. 0: Fig. 4. Palpable lesion in the right breast. On the oblique view of the breast a very suspicious lesion was seen in the upper part of the breast with a second irrgular opacity more caudal, suspicious for multifocal disease. On the 2 of the most important slices of the tomosynthesis set of images, at least 4 malignant foci could be recognized. Histology showed a multifocal invasive ductal carcinoma with 4 different invasive foci. Fig. 0: Fig. 5. Screening mammogram. On the 2D image (left side) a new cluster of irregular microcalcifications was recognized, which was suspicious for malignancy. Page 10 of 14

11 On the corresponding slice of the tomosynthesis set of images, only the most dens calcifications can be discerned, the fine low density calcifications were not seen on the different slices. Histology showed a ductal carcinoma in situ of 8 mm. Fig. 0: Fig. 6. Screening mammogram. In the lateral region of the right breast a suspicious cluster of irregular microcalcifications was recognized. On the corresponding slices of the tomosynthesis set of images, the calcifications can be delineated well, but the morfolgy is different. Histology after a stereotactic vacuum assisted biopsy showed benign fibrocystic disease with hyperplasia. Page 11 of 14

12 Conclusion These results confirmed that DBT provides more information compared to 2D in the evaluation of stellate and mass lesions, but not in de evaluation of microcalcifications. Further evaluation is needed on the difference between DBT and 2D in the BIRADS characterization of these lesions and the correlation with other technologies. Page 12 of 14

13 References Niklason LT, Christian BT, Niklason LE, Kopans DB, Castleberry DE, Opsahl-Ong BH, et al. Digital tomosynthesis in breast imaging. Radiology 1997;205(2): Rafferty EA et al. Digital mammography: novel applications. Radiol Clin North Am 2007;45: Andersson I, Ideda DM, Zackrisson S et al. Breast tomosynthesis and digital mammography: a comparison of breast cancer visibility and BIRADS classification in a population cancers with subtle mammographic findings. Eur Radiol 2008;18 (12): Gennaro G, Toledano A, di Maggio C, Baldan E, La Grassa M, Pescarini L, et al. Digital breast tomosynthesis versus digital mammography: a clinical performance study. Eur Radiol Teertstra HJ, Loo CE, van den Bosch MA, van Tinteren H, Rutgers EJ, Muller SH, et al. Breast tomosynthesis in clinical practice: initial results. Eur Radiol 2010;20: Gur D, Abrams GS, Chough DM, Ganott MA, Hakim CM, Perrin RL, et al. Digital breast tomosynthesis: observer performance study. Am J Roentgenol 2009;193(2): Page 13 of 14

14 Personal Information Chantal Van Ongeval, MD, PhD Department of Radiology Herestraat Leuven Belgium Page 14 of 14