Is There a Difference in the Diagnostic Outcomes of Calcifications Initially Identified on Synthetic Tomosynthesis Versus Full-Field Digital Mammography Screening?. Issue 133 (December 2020)

• Record Type: Journal Article
• Authors: Zhu, Haoling; Polat, Dogan; Evans, Phil; Mootz, Ann; Blackburn, Timothy; Xi, Yin; Dogan, Basak Erguvan
• Is Part Of: European journal of radiology. Issue 133(2020)
• Publication Date: 2020-12
• Subjects: Synthetic -- Tomosynthesis -- Full-field digital mammography -- Microcalcification -- Mammogram -- Digital breast; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2020.109365
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: SM resulted in a higher rate of false positive recalls compared to FFDM and Combo. SM calcifications were more likely to receive a benign designation (BI-RADS 2/3). SM calcifications unverified at FFDM had lower visibility scores on tomosynthesis. There was no difference in final diagnostic outcome between SM and FFDM/Combo. Abstract: Purpose: To compare the outcomes of microcalcifications recalled on full-field digital (FFDM) and FFDM and combined tomosynthesis (Combo) to synthetic (SM) screening mammograms. Method: We reviewed medical records, radiology, and pathology reports of all patients found to have abnormal calcifications requiring further evaluation on mammography screening at our institution between 11/1/2016-11/1/2018 and collected patient demographics, calcification morphology and distribution, and mammography technique (SM, FFDM, or Combo). We used biopsy pathology or at least 1-year imaging follow-up to establish overall diagnostic outcome (benign or malignant). Fisher's exact test was used to compare validation rates at diagnostic work-up, BI-RADS category, and final outcome of calcifications identified on each screening technique. T-test was used for continuous variables. Results: Of 699 calcifications in 596 women recalled, 176 (30%) of 596 were from SM and 420 (70%) FFDM/Combo. There was a significantly higher rate of calcifications unvalidated at diagnostic work-up for SM compared to FFDM/Combo (0.8% vs. 10%, p < 0.0001). SM calcifications were more likely to receive BI-RADS 2/3 at diagnostic work-up compared to FFDM/Combo ones (55% vs. 42%, p = 0.003). Of 346 (49%) calcifications that underwent biopsy, 88 (25%) were malignant (36% of SM vs. 22% of FFDM/Combo, OR:0.5 [95% CI: 0.3, 0.8] p = 0.01). Of 622 lesions with established diagnostic outcome, there was no difference between having an overall benign or malignant outcome between SM and FFDM/Combo (17% vs. 13%, OR: 0.8 [95% Cl: 0.5, 1.2] p = 0.27). Conclusions: Synthetic tomosynthesis screening results in a higher rate of false positive and unvalidated calcification recalls compared to FFDM/Combo.