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Agreement between digital breast tomosynthesis and pathologic tumour size for staging breast cancer, and comparison with standard mammography
M. Luke Marinovich a, *, Daniela Bernardi b, Petra Macaskill a, Anna Ventriglia b, Vincenzo Sabatino b, Nehmat Houssami a
a Sydney School of Public Health, Sydney Medical School, Edward Ford Building (A27), The University of Sydney, NSW 2006, Australia
b U.O. Senologia Clinica e Screening Mammografico, Dipartimento di Radiodiagnostica, APSS Trento, Italy
Received in revised form
Available online 10 November 2018
Purpose: Tomosynthesis is proposed to improve breast cancer assessment and staging. We compared tomosynthesis and mammography in estimating the size of newly-diagnosed breast cancers.
Methods: All pathologically-confirmed cancers detected in the STORM-2 trial (90 cancers, 85 women) were retrospectively measured on tomosynthesis by two independent readers. One reader also measured cancers on mammography. Relative mean differences (MDs) and 95% limits of agreement (LOA) with pathology were estimated for tomosynthesis and mammography within a single reader (Analysis 1) and between two readers (Analysis 2).
Results: Where cancers were detected and hence measured by both tests, tomosynthesis overestimated
pathologic size relative to mammography (Analysis 1: MD 5% versus 1%, Analysis 2: 7% versus 3%; P ¼ 0.10 both analyses). There was similar, large measurement variability for both tests (LOA range: 60% to þ166%). Overestimation by tomosynthesis was attributable to the subgroup with dense breasts (MDs ¼ 12e13% versus 4% for mammography). There was low average bias for both tests in the low-density subgroup (MDs ¼ 0e4%). LOA were larger in dense breasts for both tomosynthesis and mammography (P 0.02 all comparisons). Cancers detected only by tomosynthesis were more frequently in dense breasts (60e68%): for those tumours size was estimated with increased measure-ment variability (LOA ranging from 75% to þ293%).
Conclusions: On average, tomosynthesis overestimates pathologic tumour size in women with dense breasts; that difference is more likely to impact management in women with larger tumours. The main advantage of tomosynthesis appears to be detecting mammographically-occult cancers; however tomosynthesis less accurately measured those cancers in dense breasts (large measurement variability).
Digital breast tomosynthesis is a recent evolution of full-field digital two-dimensional (2D) mammography involving three-dimensional (3D) transformation of breast images. By acquiring images in a series of thin slices through the breast, tomosynthesis (3D-mammography) has the potential to improve visualisation of breast cancer (BC) due to a reduction in the effect of tissue super-imposition on standard 2D-mammography . Current