Detection of noncalcified breast cancer in patients with extremely dense breasts using digital breast tomosynthesis compared with full-field digital mammography

Objective: To evaluate the tumour visibility and diagnostic performance of digital breast tomosynthesis (DBT) in patients with noncalcified T 1 breast cancer. Methods: Medical records of 106 females with noncalcified T 1 invasive breast cancer who underwent DBT and full-field digital mammography (FFDM) between January 2012 and December 2014 were retrospectively reviewed. To assess tumour visibility (score 1–3), all DBT and FFDM images were reviewed by two radiologists blinded to clinicopathological information. A reference standard was established by an unblinded consensus review of all images. Clinicopathological and imaging variables were analysed based on tumour visibility. After adding 159 negative controls, the diagnostic performance of DBT + FFDM was compared with that of FFDM. Results: The tumour visibility was significantly higher through DBT + FFDM (2.5 vs 1.8; p = 0.002) than FFDM alone. Breast composition was the independent variable for tumour visibility through DBT + FFDM (extremely dense; odds ratio, 0.02; p < 0.001). Sensitivity (p = 0.642), specificity (p = 0.463), positive-predictive value (p = 0.078), and negative-predictive value (p = 0.072) of DBT + FFDM were not significantly superior to those of FFDM in 55 females with extremely dense breast composition, whereas specificity (p = 0.002) and positive-predictive value (p < 0.001) were significantly higher in 210 females with other breast compositions. Conclusion: Addition of DBT to FFDM showed no significant increase in the tumour visibility and diagnostic performance in patients with noncalcified T 1 cancer in extremely dense breasts. Advances in knowledge: Addition of DBT to FFDM did not further improve the detection of noncalcified early breast cancers in females with extremely dense breasts.