Breast MRI, digital mammography and breast tomosynthesis: comparison of three methods for early detection of breast cancer

Abstract

Breast cancer is the most common malignancy in women and early detection is important for its successful treatment. The aim of this study was to investigate the sensitivity and specificity of three methods for early detection of breast cancer: breast magnetic resonance imaging (MRI), digital mammography, and breast tomosynthesis in comparison to histopathology, as well as to investigate the intraindividual variability between these modalities. We included 57 breast lesions, each detected by three diagnostic modalities: digital mammography, breast MRI, and breast tomosynthesis, and subsequently confirmed by histopathology. Breast Imaging-Reporting and Data System (BI-RADS) was used for characterizing the lesions. One experienced radiologist interpreted all three diagnostic modalities. Twenty-nine of the breast lesions were malignant while 28 were benign. The sensitivity for digital mammography, breast MRI, and breast tomosynthesis, was 72.4%, 93.1%, and 100%, respectively; while the specificity was 46.4%, 60.7%, and 75%, respectively. Receiver operating characteristics (ROC) curve analysis showed an overall diagnostic advantage of breast tomosynthesis over both breast MRI and digital mammography. The difference in performance between breast tomosynthesis and digital mammography was significant (p <0.001), while the difference between breast tomosynthesis and breast MRI was not significant (p=0.20).

FIGURE 1

ROC curves for breast MRI, digital mammography (DM) and breast tomosynthesis (DBT).

FIGURE 2

A 54-year-old patient who was referred to our institution for an additional diagnostic procedure because of the mass in the left breast seen with ultrasound (no image available). Digital mammography MLO projection right breast (a), left breast (b) classified as BI-RADS 1. Breast MRI, MIP (c) two lesions in the right breast with slow initial enhancement and a wash-out curve, classified as BI-RADS 5. Breast tomosynthesis right breast MLO projection (d) two spiculated masses classified as BI-RADS 5. Histopathology: Ductal invasive carcinoma, both lesions..