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. 2023 May 19;9(5):103.
doi: 10.3390/jimaging9050103.

Tomosynthesis-Detected Architectural Distortions: Correlations between Imaging Characteristics and Histopathologic Outcomes

Giovanna Romanucci  1 , Francesca Fornasa  2 , Andrea Caneva  3 , Claudia Rossati  1 , Marta Mandarà  4 , Oscar Tommasini  5 , Rossella Rella  5
Affiliations

Tomosynthesis-Detected Architectural Distortions: Correlations between Imaging Characteristics and Histopathologic Outcomes

Giovanna Romanucci et al. J Imaging. .

Abstract

Objective: to determine the positive predictive value (PPV) of tomosynthesis (DBT)-detected architectural distortions (ADs) and evaluate correlations between AD's imaging characteristics and histopathologic outcomes.

Methods: biopsies performed between 2019 and 2021 on ADs were included. Images were interpreted by dedicated breast imaging radiologists. Pathologic results after DBT-vacuum assisted biopsy (DBT-VAB) and core needle biopsy were compared with AD detected by DBT, synthetic2D (synt2D) and ultrasound (US).

Results: US was performed to assess a correlation for ADs in all 123 cases and a US correlation was identified in 12/123 (9.7%) cases, which underwent US-guided core needle biopsy (CNB). The remaining 111/123 (90.2%) ADs were biopsied under DBT guidance. Among the 123 ADs included, 33/123 (26.8%) yielded malignant results. The overall PPV for malignancy was 30.1% (37/123). The imaging-specific PPV for malignancy was 19.2% (5/26) for DBT-only ADs, 28.2% (24/85) for ADs visible on DBT and synth2D mammography and 66.7% (8/12) for ADs with a US correlation with a statistically significant difference among the three groups (p = 0.01).

Conclusions: DBT-only ADs demonstrated a lower PPV of malignancy when compared with syntD mammography, and DBT detected ADs but not low enough to avoid biopsy. As the presence of a US correlate was found to be related with malignancy, it should increase the radiologist's level of suspicion, even when CNB returned a B3 result.

Keywords: B3 lesions; Breast Cancer Screening Program; DBT-vacuum assisted biopsy; architectural distortion; breast cancer; breast imaging; synthetic2D; tomosynthesis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study.
Figure 2
Figure 2
69 years old woman who presented for screening mammography with an AD of 25 mm, in left upper-external quadrant (circle). AD was fully appreciable on DBT images (a,b), on DBT spot compression (c) and on synt2D images (d,e). It showed US correlate (f), therefore US-CNB was performed. At histological analysis, a tubular carcinoma was found.
See this image and copyright information in PMC

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