Digital Breast Tomosynthesis: Initial Experience in 98 Women with Abnormal Digital Screening Mammography
Steven P. Poplack1,
Tor D. Tosteson2,3,
Christine A. Kogel1 and
Helene M. Nagy1
1 Department of Radiology, Dartmouth-Hitchcock Medical Center, One Medical
Center Dr., Lebanon, NH 03756.
2 Department of Community and Family Medicine, Dartmouth Medical School,
Hanover, NH.
3 Norris Cotton Cancer Center, Lebanon, NH.
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Fig. 1 —Photograph of prototype tomosynthesis unit (Genesis,
Hologic). During tomosynthesis acquisition, the X-ray tube moves through
28° arc and obtains 11 low-dose exposures while rest of unit remains
stationary. FFDM = full-field digital mammography.
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Fig. 2A —Comparison of tomosynthesis with focal magnification film-screen
mammography in 58-year-old woman with clustered pleomorphic calcifications
representing fibroadenomatous change at 11-gauge core needle biopsy.
Left-breast clustered pleomorphic calcifications (arrows) are shown
in single slice (1-mm thick) of craniocaudal digital tomosynthesis examination
(A), craniocaudal focal magnification film-screen mammogram (B),
single slice (1-mm thick) of mediolateral tomosynthesis examination
(C), and mediolateral focal magnification film-screen mammogram
(D).
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Fig. 2B —Comparison of tomosynthesis with focal magnification film-screen
mammography in 58-year-old woman with clustered pleomorphic calcifications
representing fibroadenomatous change at 11-gauge core needle biopsy.
Left-breast clustered pleomorphic calcifications (arrows) are shown
in single slice (1-mm thick) of craniocaudal digital tomosynthesis examination
(A), craniocaudal focal magnification film-screen mammogram (B),
single slice (1-mm thick) of mediolateral tomosynthesis examination
(C), and mediolateral focal magnification film-screen mammogram
(D).
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Fig. 2C —Comparison of tomosynthesis with focal magnification film-screen
mammography in 58-year-old woman with clustered pleomorphic calcifications
representing fibroadenomatous change at 11-gauge core needle biopsy.
Left-breast clustered pleomorphic calcifications (arrows) are shown
in single slice (1-mm thick) of craniocaudal digital tomosynthesis examination
(A), craniocaudal focal magnification film-screen mammogram (B),
single slice (1-mm thick) of mediolateral tomosynthesis examination
(C), and mediolateral focal magnification film-screen mammogram
(D).
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Fig. 2D —Comparison of tomosynthesis with focal magnification film-screen
mammography in 58-year-old woman with clustered pleomorphic calcifications
representing fibroadenomatous change at 11-gauge core needle biopsy.
Left-breast clustered pleomorphic calcifications (arrows) are shown
in single slice (1-mm thick) of craniocaudal digital tomosynthesis examination
(A), craniocaudal focal magnification film-screen mammogram (B),
single slice (1-mm thick) of mediolateral tomosynthesis examination
(C), and mediolateral focal magnification film-screen mammogram
(D).
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Fig. 3 —Flowchart shows reason for no tomosynthesis recall in 52
abnormalities detected with digital screening mammography. Threshold
differences = digital screening recalled by clinical radiologist that would
not have been recalled by study radiologist because of higher recall threshold
of study radiologist. Positioning = difference in breast positioning between
digital screening mammography (abnormality incompletely visualized) and
tomosynthesis (questioned abnormality [i.e., pectoralis muscle and adjacent
tissue] included entirely).
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Fig. 4B —84-year-old woman with infiltrating lobular carcinoma. Single slice
from left craniocaudal tomosynthesis examination shows irregularly shaped mass
with spiculated margins (arrows) and central low density
(circle), suggestive of fat.
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Copyright © 2007 by the American Roentgen Ray Society.
