The role of digital breast tomosynthesis in the breast assessment clinic: a review

Abstract

Mammography has long been considered as the primary technique in breast cancer detection and assessment. Despite low specificity, mammography has been preferred over other contemporary techniques such as magnetic resonance imaging (MRI), computed tomography (CT) and ultrasonography (US) due to superior sensitivity and significant health economic benefits. The development of a new technique, a limited angle cone beam pseudo-three-dimensional tomosynthesis, digital breast tomosynthesis (DBT), has gained momentum. Several preliminary studies and ongoing trials are showing evidence of the benefits of DBT in improving lesion visibility, accuracy of cancer detection and observer performance. This raises the possibility of adoption of DBT in the breast cancer assessment clinic, wherein confirming or dismissing the presence of malignancy (at the potential site identified during screening) is of utmost importance. Identification of suspected malignancy in terms of lesion characteristics and location is also essential in assessment. In this literature review, we evaluate the role of DBT for use in breast cancer assessment and its future in biopsy.

Keywords: DBT; Assessment; biopsy; breast cancer; diagnosis; digital breast tomosynthesis.

Figure 1

Schematic of standard digital breast tomosynthesis (DBT) system where an X‐ray source moves in an arc and steps and shoots an X‐ray beam that falls on the breast compressed between the compression paddle and the support plate. The digital breast image obtained for each acquisition of the moving X‐ray source is then processed via a software program to obtain 3D‐like DBT images.

Figure 2

Workflow of screening and assessment scenarios, describing the steps involved in diagnosing breast cancer. The screening process is the first step in breast cancer detection, followed by assessment if suspicious findings are identified during screening.