Digital breast tomosynthesis and automated breast ultrasound: added values in women with dense breasts

Abstract Background Dense breast is one of the challenging cases in breast imaging; in both screening and diagnostic settings. Digital mammography (DM) is the first line modality for breast imaging. Women with heterogeneously dense and extremely dense breast could not get much benefit from DM as its sensitivity is markedly decreased. And so many modalities have been integrated in the strategies of dense breast imaging. We aim in this study to assess the diagnostic performance of digital breast tomosynthesis (DBT) and automated breast ultrasound (ABUS) in mammographic dense breast. Results A total of 85 patients with dense breasts were enrolled in this prospective study. Digital mammography was performed in combination with DBT for dense breasts. ABUS was then performed in the same session. The DBT and ABUS images were evaluated by two experienced radiologists in consensus; both observers were blinded to the pathological data. Final standard references were the result of the pathological examination for the biopsied lesions, the typical benign aspect of the unbiopsied lesions, and the unchanged features of the solid lesions at Hand-Held US/ABUS after 2 years. Out of 85 patients, 100 lesions were detected, 68 lesions were benign, 31 lesions were diagnosed as malignant and one lesion was borderline. Sensitivity was 93.75% for both DBT (30/31) and ABUS (30/31) and negative predictive value was 96.7% for DBT (59/61) and 96.8% (60/62) for ABUS. Specificity and positive predictive value for DBT were 86.8% (59/68) and 76.9% (30/39), respectively. Specificity and positive predictive value for ABUS were 88.2% (60/68) and 78.9% (30/38), respectively. ABUS showed higher diagnostic accuracy than that of DBT (ABUS: 90%, 90/100; DBT:89%, 89/100). Conclusion ABUS detected more lesions with higher specificity and more accuracy while the use of DBT was more beneficial in the case of microcalcifications.