Efficacy of digital breast tomosynthesis combined with magnetic resonance imaging in the diagnosis of early breast cancer

BACKGROUND The incidence and mortality rate of breast cancer in China rank 120th and 163rd,worldwide,respectively.The incidence of breast cancer is on the rise;the risk increases with age but is slightly reduced after menopause.Early screening,diagnosis,and timely determination of the best treatment plan can ensure clinical efficacy and prognosis.AIM To evaluate the clinical value of magnetic resonance imaging(MRI) combined with digital breast tomosynthesis(DBT) in diagnosing early breast cancer and the effect of breast-conserving surgery by arc incision.METHODS This study was divided into two parts.Firstly,110 patients with early breast cancer confirmed by pathological examination and 110 with benign breast diseases diagnosed simultaneously in Changzhi People’s Hospital of Shanxi Province and Shanxi Dayi Hospital from May 2019 to September 2020 were included in the breast cancer group and the benign group,respectively.Both groups underwent DBT and MRI examination,and the pathological results were used as the gold standard to evaluate the effectiveness of the combined application of DBT and MRI in the diagnosis of early breast cancer.Secondly,according to the operation method,110 patients with breast cancer were divided into either a breast-conserving group(69 patients) or a modified radical mastectomy group(41 patients).The surgical effect,cosmetic effect,and quality of life of the two groups were compared.RESULTS Among the 110 cases of breast cancer,66 were of invasive ductal carcinoma(60.00%),and 22 were of ductal carcinoma in situ(20.00%).Among the 110 cases of benign breast tumors,55 were of breast fibromas(50.00%),and 27 were of breast adenosis(24.55%).The sensitivity,specificity,and area under the curve(AUC) of DBT in the differential diagnosis of benign and malignant breast tumors were 73.64%,84.55%,and 0.791,respectively.The sensitivity,specificity,and AUC of MRI in the differential diagnosis of benign and malignant breast tumors were 84.55%,85.45%,and 0.850,respectively.The sensitivity,specificity,and AUC of DBT combined with MRI in the differential diagnosis of benign and malignant breast tumors were 97.27%,93.64%,and 0.955,respectively.The blood loss,operation time and hospitalization time of the breast-conserving group were significantly lower than those of the modified radical treatment group,and the difference was statistically significant(P < 0.05).After 3 mo of observation,the breast cosmetic effect of the breast-conserving group was better than that of the modified radical group,and the difference was statistically significant(P < 0.05).Before surgery,the quality-of-life scores of the breast-conserving and modified radical mastectomy groups did not differ(P > 0.05).Three months after surgery,the quality-of-life scores in both groups were higher than those before surgery(P < 0.05),and the quality-of-life score of the breast-conserving group was higher than that of the modified radical group(P < 0.05).In the observation of tumor recurrence rate two years after the operation,four patients in the breast-conserving group and one in the modified radical treatment group had a postoperative recurrence.There was no significant difference in the recurrence rate between the two groups(χ2 = 0.668,P = 0.414 > 0.05).CONCLUSION MRI combined with DBT in diagnosing early breast cancer can significantly improve the diagnostic efficacy compared with the two alone.Breast-conserving surgery leads to better cosmetic breast effects and reduces the impact of surgery on postoperative quality of life.

Comparison between Visualization of Microcalcifications by Digital Breast Tomosynthesis and Full-Field Digital Mammography

Objective: To date, few studies have compared the diagnostic performance and visibility of microcalcifications obtained using digital breast tomosynthesis (DBT) with those obtained from full-field digital mammography (FFDM). The visualization and characterization of microcalcifications with DBT remain controversial. The purpose of this study was to compare the visibility of microcalcifications and determine whether DBT exhibits a diagnostic advantage for visualizing microcalcifications over FFDM. Methods: We retrospectively reviewed 120 cases including DBT and FFDM imaging (60 histologically verified as breast cancers and 60 as benign microcalcifications or normal). DBT images with a wide scan-angle of 50° and FFDM images were obtained using a flat-panel system (MAMMOMAT Inspiration, Siemens). Images were independently reviewed by four board-certified radiologists and evaluated for the presence of microcalcifications, probability of malignancy (BI-RADS classification), and visibility. Results: In predicting the malignancy of detected microcalcifications, no significant difference was found between readers’ areas under the receiver operating characteristic curve for DBT and FFDM (p = 0.068). The visibility scores of detected microcalcifications were 3.74 ± 1.06 for DBT and 3.46 ± 0.93 for FFDM, respectively. The visibility of microcalcifications when using DBT was found to be significantly superior to that of FFDM (p < 0.05). Conclusion: Our results suggest that the image quality of DBT with a wide scan-angle is comparable or superior to that obtained with FFDM in terms of both visibility and assessment of microcalcifications.