Digital Breast Tomosynthesis Screening

Eun Young Chae; Hak Hee Kim

doi:10.3348/jksr.2019.80.1.19

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Chae and Kim: Digital Breast Tomosynthesis Screening

Review Article

J Korean Soc Radiol 2019;80(1):19-31.

Published online: 20 January 2019

DOI: https://doi.org/10.3348/jksr.2019.80.1.19

Digital Breast Tomosynthesis Screening

Eun Young Chae, MD^∗, Hak Hee Kim, MD

Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

^∗Corresponding author Eun Young Chae, MD Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel 82-2-3010-1709 Fax 82-2-476-0090 E-mail chaeey@amc.seoul.kr

Received 9 November 2018 Revised 22 December 2018 Accepted 8 January 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Digital breast tomosynthesis (DBT) has been shown to be a promising imaging technique for breast cancer detection. DBT involves acquisition of a series of images in different planes over a limited angular range, and their subsequent reconstruction into a quasi-three-dimensional breast volume. This reduces the effects of tissue overlap. This review aims to describe the key features of DBT, including technique, results from recent retrospective and prospective clinical studies, and issues with DBT as a screening tool.

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Fig. 1.

Digital breast tomosynthesis images with multiple low-dose X-ray exposures are obtained as the X-ray tube moves over a limited angular range above the breast. These images are reconstructed into a quasi-three-dimensional breast volume.

Fig. 2.

A 55-year-old woman who underwent DBT and FFDM for screening. A. CC view of the right breast on FFDM shows heterogeneously dense composition without definite focal abnormality. B. CC view on DBT shows an irregular mass (arrow) in the outer portion of the right breast. C. Ultrasonography shows a 4-mm hypoechoic mass in the right breast. Invasive ductal carcinoma was diagnosed on ultrasound-guided biopsy. CC = craniocaudal, DBT = digital breast tomosynthesis, FFDM = full-field digital mammography

Fig. 3.

Example of superimposed tissue that mimics an asymmetry on FFDM. A. CC view on FFDM shows an asymmetry (arrow) in the inner portion of the left breast that needs to be recalled without DBT images. B, C. CC view on DBT (B) and CC view on synthetic mammogram (C) reveals fibroglandular tissues (arrows) without associated mass. The patient can return for the annual screening. CC = craniocaudal, DBT = digital breast tomosynthesis, FFDM = full-field digital mammography

Fig. 4.

A 45-year-old woman with invasive ductal carcinoma. A. CC view on full-field digital mammography shows a subtle architectural distortion (arrow) in the right breast. B. CC view on digital breast tomosynthesis shows a more conspicuous mass with spiculated margins, which is highly suggestive of malignancy (arrow). CC = craniocaudal

Fig. 5.

A 57-year-old woman who underwent DBT and FFDM for screening. A. The MLO view on FFDM shows an irregular-shaped, isodense mass with indistinct margins (arrows) in the upper portion of the left breast. B. MLO view on DBT demonstrates an oval-shaped, hyperdense mass with circumscribed margins, likely a benign finding. C. Ultrasonography shows a 17-mm, oval-shaped, isoechoic mass in the left breast. It was suspected to be a benign mass and was unchanged at the 5-year follow-up. DBT = digital breast tomosynthesis, FFDM = full-field digital mammography, MLO = mediolateral oblique

Fig. 6.

A 46-year-old woman with invasive ductal carcinoma. A. Craniocaudal view on FFDM shows an oval-shaped, isodense mass (arrows) in the central portion of the right breast. B. An irregular mass with spiculated margins (arrows) is clearly revealed on digital breast tomosynthesis. An oval isodense mass (arrowheads) is also noted in the inner portion of the right breast, which was not clearly visible on FFDM. It was suspected to be a benign mass on ultrasonography (not shown). FFDM = full-field digital mammography

Fig. 7.

A 52-year-old woman with ductal carcinoma in situ of the left breast. A, B. Fⁱⁿe pleomorphic ca^lcifications (squares) in the left upper breast are equally visible on full-field digital mammography (A) and synthetic^mam- mography (B).

Table 1.

Comparison of Clinical Digital Breast Tomosynthesis Symtems

Manufacturer (Model)	Hologic (Selenia Dimensions)	GE Healthcare (SenoClaire)	Siemens Healthineers (Mammomat Inspiration)
Scanning angle (º)	15	25	50
No. of projection	15	9	25
Scan time (sec)	4	7	24
X-ray tube motion	Continuous	Step and shoot	Continuous
Reconstruction	Filtered back projection	Iterative	Filtered back projection

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