Digital Breast Tomosynthesis versus Full-Field Digital Mammography—Which Modality Provides More Accurate Prediction of Margin Status in Specimen Radiography?

Digital Breast Tomosynthesis versus Full-Field Digital Mammography—Which Modality Provides More Accurate Prediction of Margin Status in Specimen Radiography?

Abstract Objectives To evaluate the reliability of tumor margin assessment in specimen radiography (SR) using digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) in comparison to postoperative histopathology margin status as the gold standard. Methods After ethics committee...

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Bibliographic Details
Published in:European journal of radiology Vol. 93; pp. 258 - 264
Main Authors: Amer, Heba A, Schmitzberger, Florian, Ingold-Heppner, Barbara, Kussmaul, Julia, El Tohamy, Manal F, Tantawy, Hazim I, Hamm, B, Makowski, M, Fallenberg, Eva M
Format: Journal Article
Language:English
Published: Ireland Elsevier B.V 01-08-2017
Subjects:
Breast - pathology
Breast - surgery
Breast Neoplasms - diagnostic imaging
Breast Neoplasms - pathology
Breast Neoplasms - surgery
Carcinoma, Intraductal, Noninfiltrating - diagnostic imaging
Carcinoma, Intraductal, Noninfiltrating - pathology
Carcinoma, Intraductal, Noninfiltrating - surgery
Digital breast tomosynthesis
Digital mammography
Female
Humans
Mammography - methods
Margin evaluation
Margins of Excision
Middle Aged
Radiographic Image Enhancement - methods
Radiology
Reproducibility of Results
Specimen radiography
Ultrasonography, Mammary - methods
invasive ductal carcinoma/carcinoma of non-special type
digital breast tomosynthesis
FFDM
R1/R2
Margin evaluation
ductal carcinoma in situ
breast conserving surgery
BCS
DCIS
DBT
full-field digital mammography
specimen Radiography
Reader 1/Reader 2
digital mammography
SR
IDC/NST
Digital breast tomosynthesis
Digital mammography
Specimen radiography
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Summary:Abstract Objectives To evaluate the reliability of tumor margin assessment in specimen radiography (SR) using digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) in comparison to postoperative histopathology margin status as the gold standard. Methods After ethics committee approval, 102 consecutive patients who underwent breast conservative surgery for nonpalpable proven breast cancer were prospectively included. All patients underwent ultrasound/mammography-guided wire localization of their lesions. After excision, each specimen was marked for orientation and imaged using FFDM and DBT. Two blinded radiologists (R1, R2) independently analyzed images acquired with both modalities. Readers identified in which direction the lesion was closest to the specimen margin and to measure the margin width. Their findings were compared with the final histopathological analysis. True positive margin status was defined as a margin measuring <1 mm for invasive cancer and 5 mm for ductal carcinoma in situ (DCIS) at imaging and pathology. Results For FFDM, correct margin direction was identified in 45 cases (44%) by R1 and in 37 cases (36%) by R2. For DBT, 69 cases (68%) were correctly identified by R1 and 70 cases (69%) by R2. Overall accuracy was 40% for FFDM and 69% for DBT; the difference was statistically significant (p < 0.0001). Sensitivity in terms of correct assessment of margin status was significantly better for DBT than FFDM (77% versus 62%). Conclusion SR using DBT is significantly superior to FFDM regarding identification of the closest margin and sensitivity in assessment of margin status.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:0720-048X
1872-7727
DOI:10.1016/j.ejrad.2017.05.041