Korean Journal of Radiology

  • 제20권1호
  • /
  • Pages.58-68
  • /
  • 2019
  • /
  • 1229-6929(pISSN)
  • /
  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

Factors Affecting Breast Cancer Detectability on Digital Breast Tomosynthesis and Two-Dimensional Digital Mammography in Patients with Dense Breasts

  • Soo Hyun Lee (Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Mi Jung Jang (Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Sun Mi Kim (Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Bo La Yun (Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Jiwon Rim (Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Jung Min Chang (Department of Radiology, Seoul National University College of Medicine) ;
  • Bohyoung Kim (Division of Biomedical Engineering, Hankuk University of Foreign Studies) ;
  • Hye Young Choi (Department of Radiology, Gyeongsang National University Hospital and College of Medicine, Gyeongsang National University)
  • 투고 : 2018.01.04
  • 심사 : 2018.07.25
  • 발행 : 2019.01.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: To compare digital breast tomosynthesis (DBT) and conventional full-field digital mammography (FFDM) in the detectability of breast cancers in patients with dense breast tissue, and to determine the influencing factors in the detection of breast cancers using the two techniques. Materials and Methods: Three blinded radiologists independently graded cancer detectability of 300 breast cancers (288 women with dense breasts) on DBT and conventional FFDM images, retrospectively. Hormone status, histologic grade, T stage, and breast cancer subtype were recorded to identify factors affecting cancer detectability. The Wilcoxon signed-rank test was used to compare cancer detectability by DBT and conventional FFDM. Fisher's exact tests were used to determine differences in cancer characteristics between detectability groups. Kruskal-Wallis tests were used to determine whether the detectability score differed according to cancer characteristics. Results: Forty breast cancers (13.3%) were detectable only with DBT; 191 (63.7%) breast cancers were detected with both FFDM and DBT, and 69 (23%) were not detected with either. Cancer detectability scores were significantly higher for DBT than for conventional FFDM (median score, 6; range, 0-6; p < 0.001). The DBT-only cancer group had more invasive lobular-type breast cancers (22.5%) than the other two groups (i.e., cancer detected on both types of image [both-detected group], 5.2%; cancer not detected on either type of image [both-non-detected group], 7.3%), and less detectability of ductal carcinoma in situ (5% vs. 16.8% [both-detected group] vs. 27.5% [both-non-detected group]). Low-grade cancers were more often detected in the DBT-only group than in the both-detected group (22.5% vs. 10%, p = 0.026). Human epidermal growth factor receptor-2 (HER-2)-negative cancers were more often detected in the DBT-only group than in the both-detected group (92.3% vs. 70.5%, p = 0.004). Cancers surrounded by mostly glandular tissue were detected less often in the DBT only group than in the both-non-detected group (10% vs. 31.9%, p = 0.016). DBT cancer detectability scores were significantly associated with cancer type (p = 0.012), histologic grade (p = 0.013), T and N stage (p = 0.001, p = 0.024), proportion of glandular tissue surrounding lesions (p = 0.013), and lesion type (p < 0.001). Conclusion: Invasive lobular, low-grade, or HER-2-negative cancer is more detectable with DBT than with conventional FFDM in patients with dense breasts, but cancers surrounded by mostly glandular tissue might be missed with both techniques.

키워드

과제정보

This study was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (No. 2017R1D1A1B03033975).

참고문헌

  1. Pisano ED, Gatsonis C, Hendrick E, Yaffe M, Baum JK, Acharyya S, et al.; Digital Mammographic Imaging Screening Trial (DMIST) Investigators Group. Diagnostic performance of digital versus film mammography for breast-cancer screening. N Engl J Med 2005;353:1773-1783
  2. Kopans DB. The most recent breast cancer screening controversy about whether mammographic screening benefits women at any age: nonsense and nonscience. AJR Am J Roentgenol 2003;180:21-26
  3. Baker JA, Lo JY. Breast tomosynthesis: state-of-the-art and review of the literature. Acad Radiol 2011;18:1298-1310
  4. Lei J, Yang P, Zhang L, Wang Y, Yang K. Diagnostic accuracy of digital breast tomosynthesis versus digital mammography for benign and malignant lesions in breasts: a meta-analysis. Eur Radiol 2014;24:595-602
  5. Yang TL, Liang HL, Chou CP, Huang JS, Pan HB. The adjunctive digital breast tomosynthesis in diagnosis of breast cancer. Biomed Res Int 2013 Jun 17 [Epub]. https://doi.org/10.1155/2013/597253
  6. Mun HS, Kim HH, Shin HJ, Cha JH, Ruppel PL, Oh HY, et al. Assessment of extent of breast cancer: comparison between digital breast tomosynthesis and full-field digital mammography. Clin Radiol 2013;68:1254-1259
  7. Gilbert FJ, Tucker L, Gillan MG, Willsher P, Cooke J, Duncan KA, et al. Accuracy of digital breast tomosynthesis for depicting breast cancer subgroups in a UK retrospective reading study (TOMMY Trial). Radiology 2015;277:697-706
  8. Kim JY, Kang HJ, Shin JK, Lee NK, Song YS, Nam KJ, et al. Biologic profiles of invasive breast cancers detected only with digital breast tomosynthesis. AJR Am J Roentgenol 2017;209:1411-1418
  9. Skaane P, Bandos AI, Gullien R, Eben EB, Ekseth U, Haakenaasen U, et al. Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology 2013;267:47-56
  10. Ciatto S, Houssami N, Bernardi D, Caumo F, Pellegrini M, Brunelli S, et al. Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study. Lancet Oncol 2013;14:583-589
  11. Rose SL, Tidwell AL, Bujnoch LJ, Kushwaha AC, Nordmann AS, Sexton R Jr. Implementation of breast tomosynthesis in a routine screening practice: an observational study. AJR Am J Roentgenol 2013;200:1401-1408
  12. Greenberg JS, Javitt MC, Katzen J, Michael S, Holland AE. Clinical performance metrics of 3D digital breast tomosynthesis compared with 2D digital mammography for breast cancer screening in community practice. AJR Am J Roentgenol 2014;203:687-693
  13. Andersson I, Ikeda DM, Zackrisson S, Ruschin M, Svahn T, Timberg P, et al. Breast tomosynthesis and digital mammography: a comparison of breast cancer visibility and BIRADS classification in a population of cancers with subtle mammographic findings. Eur Radiol 2008;18:2817-2825
  14. Nakashima K, Uematsu T, Itoh T, Takahashi K, Nishimura S, Hayashi T, et al. Comparison of visibility of circumscribed masses on Digital Breast Tomosynthesis (DBT) and 2D mammography: are circumscribed masses better visualized and assured of being benign on DBT? Eur Radiol 2017;27:570-577
  15. Nam KJ, Han BK, Ko ES, Choi JS, Ko EY, Jeong DW, et al. Comparison of full-field digital mammography and digital breast tomosynthesis in ultrasonography-detected breast cancers. Breast 2015;24:649-655
  16. Svahn TM, Chakraborty DP, Ikeda D, Zackrisson S, Do Y, Mattsson S, et al. Breast tomosynthesis and digital mammography: a comparison of diagnostic accuracy. Br J Radiol 2012;85:e1074-e1082
  17. Wang WS, Hardesty L, Borgstede J, Takahashi J, Sams S. Breast cancers found with digital breast tomosynthesis: a comparison of pathology and histologic grade. Breast J 2016;22:651-656
  18. Bernardi D, Macaskill P, Pellegrini M, Valentini M, Fanto C, Ostillio L, et al. Breast cancer screening with tomosynthesis (3D mammography) with acquired or synthetic 2D mammography compared with 2D mammography alone (STORM-2): a population-based prospective study. Lancet Oncol 2016;17:1105-1113
  19. Lang K, Andersson I, Zackrisson S. Breast cancer detection in digital breast tomosynthesis and digital mammography-a side-by-side review of discrepant cases. Br J Radiol 2014;87:20140080
  20. Skaane P, Gullien R, Bjorndal H, Eben EB, Ekseth U, Haakenaasen U, et al. Digital breast tomosynthesis (DBT): initial experience in a clinical setting. Acta Radiol 2012;53:524-529
  21. Friedewald SM, Rafferty EA, Rose SL, Durand MA, Plecha DM, Greenberg JS, et al. Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA 2014;311:2499-2507