What question did this study set out to answer?

The aim is to evaluate how digital breast tomosynthesis (DBT) affects BI-RADS categorization compared to conventional mammography (MMG), focusing on different breast densities.

February 5, 2026Open Access

The Effect of Digital Breast Tomosynthesis on BI-RADS Categorization in Different Breast Densities: A Retrospective Evaluation

Key Points

The aim is to evaluate how digital breast tomosynthesis (DBT) affects BI-RADS categorization compared to conventional mammography (MMG), focusing on different breast densities.
Retrospective study of 520 women aged 35–85 who had both MMG and DBT
Craniocaudal views for MMG and mediolateral oblique views for DBT were used
Patients categorized into breast density types A–D
Images reviewed in consensus by two experienced radiologists
BI-RADS categories and lesion types were recorded and analyzed.
Significant differences in BI-RADS classifications were noted, particularly in dense breasts
21.6% of BI-RADS 2 cases on MMG were upgraded to BI-RADS 3 or 4 with DBT
6.3% of BI-RADS 3 cases were downgraded with DBT
33% of BI-RADS 4 cases showed downgrading
91.3% of patients exhibited at least one pathological finding.

Abstract

Objectives: This study aimed to evaluate the impact of digital breast tomosynthesis (DBT) on BI-RADS categorization compared to conventional mammography (MMG), across different mammographic breast density types. Methods: In this retrospective study, 520 female patients aged 35–85 years who underwent both MMG and DBT between 2023 and 2025 were included. Standard craniocaudal (CC) views were acquired for MMG and mediolateral oblique (MLO) views for DBT. Synthetic MLO (sMLO) images were automatically generated by the device from DBT data. Patients were categorized according to the breast density (Type A–D), and all images were reviewed in consensus by two experienced radiologists. Breast Imaging Reporting and Data System (BI-RADS) categories, lesion types, were recorded. BI-RADS categorizations from MMG and DBT were compared overall and within density subgroups. Results: The mean age was 53.0 ± 9.9 years. Breast density distribution was: Type A (3.8%, n=20), B (28.5%, n= 148), C (43.5%, n=226), and D (24.2%, n=126). BI-RADS classifications differed significantly between MMG and DBT, especially in dense breasts. Of the BI-RADS 2 cases on MMG, 21.6% (n=64) were reclassified as BI-RADS 3 or 4 with DBT, while 6.3% (n=7) of BI-RADS 3 cases were downgraded. BI-RADS 5 categorization showed complete agreement between modalities, though 33% (n=5) of BI-RADS 4 cases were downgraded. At least one pathological finding was observed in 91.3% (n=475) of patients, most commonly nodular opacities (57.1%, n=297), vascular wall calcifications (13.3%, n=69), and coarse calcifications (5.4%, n=28). McNemar analysis revealed significant reclassification between BI-RADS 2 and 3 in Types C and D (P0.001). Conclusions: DBT significantly alters BI-RADS categorization in dense breasts. These findings support the potential role of DBT as a complementary tool in screening protocols, particularly for patients with heterogeneously dense or extremely dense breast tissue.

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Cite This Study

Şanlı et al. (Tue,) studied this question.

synapsesocial.com/papers/6984358ff1d9ada3c1fb47e7 https://doi.org/https://doi.org/10.18621/eurj.1843405

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