The utility of breast cone-beam computed tomography, ultrasound, and digital mammography for detecting malignant breast tumors: A prospective study with 212 patients

https://doi.org/10.1016/j.ejrad.2015.11.029Get rights and content

Highlights

  • Breast cone-beam computed tomography provides high-quality images of the breast.

  • BCBCT helps radiologists to diagnose malignant breast lesions.

  • 3D visualization helps clinicians to make a biopsy or surgical plan.

  • CE-BCBCT improved cancer diagnosis in more dense breasts.

Abstract

Purpose

Breast cone-beam computed tomography (BCBCT) is a flat-panel detector (FPD)-based X-ray imaging system that provides high-quality images of the breast. The purpose of this study was to investigate the ability to detect breast abnormalities using non-contrast BCBCT and contrast-enhanced BCBCT (BCBCT and CE-BCBCT) compared to ultrasound (US) and digital mammography (MG).

Materials and methods

A prospective study was performed from May 2012 to August 2014. Ninety-two patients (172 lesions) underwent BCBCT alone, and 120 patients (270 lesions) underwent BCBCT and CE-BCBCT, all the patients underwent US and MG.

Results

Cancer diagnosis was confirmed pathologically in 102 patients (110 lesions). BCBCT identified 97 of 110 malignant lesions, whereas 93 malignant lesions were identified using MG and US. The areas under the receiver operating curves (AUCs) for breast cancer diagnosis were 0.861 (BCBCT), 0.856 (US), and 0.829 (MG). CE-BCBCT improved cancer diagnostic sensitivity by 20.3% (78.4–98.7%). The AUC values were 0.869 (CE-BCBCT), 0.846 (BCBCT), 0.834 (US), and 0.782 (MG).

Conclusion

In this preliminary study, BCBCT was found to accurately identify malignant breast lesions in a diagnostic setting. CE-BCBCT provided additional information and improved cancer diagnosis in style c or d breasts compared to the use of BCBCT, US, or MG alone.

Introduction

Early detection of breast cancer has been demonstrated to decrease breast cancer mortality during last 30 years [1], [2], [3], [4]. The limits of mammography are still well documented, which result from poor contrast between the breast and breast lesions and the variety of pathologic presentations [5], [6]. Furthermore, breast density and tissue distribution differ among women, adding to the complexity of interpretation.

Breast cone-beam computed tomography (BCBCT) is a flat-panel detector (FPD)-based system that is used to improve the sensitivity and specificity of breast cancer detection and characterization [7], [8], [9]. This rapidly evolving breast-specific imaging modality exhibits unique advantages for diagnostic breast imaging (Fig. 1). BCBCT provides high-quality images and real-time 3D visualization of the breast. Preliminary research shows that breast coverage and radiation dose using BCBCT is comparable to that required for conventional diagnostic MG, and this technique has the potential to further characterize high-risk breast lesions that have been identified in screening by MG or US [7], [10], [11].

This study was performed to evaluate the ability of BCBCT or/and CE-BCBCT to detect malignant breast lesions and to compare these techniques to conventional diagnostic MG and US, especially for women with dense breasts.

Section snippets

Patients

This prospective study was approved by the Ethics Committee for the Protection and Privacy of Persons Involved in Clinical Trials. Written informed consent was obtained from all patients.

Each patient underwent clinical examination of each breast, including digital MG, US, BCBCT or CE-BCBCT, and biopsies of suspicious lesions detected by US or MG. If lesions seen on Cone Beam CT only, MRI should be suggest to the patient and MRI-guided biopsy would be perform if necessary. The patient

Patients

A total of 212 patients with assessments of BI-RADS® 1–5 were enrolled from May 2012 to August 2014: 424 BCBCT and 240CE-BCBCT scans of 424 breasts were performed, and 442 lesions were observed in this study; 12 breasts were excluded due to BI-RADS® assessments of 0 or 6.

The median age of the examined patients was 48 years (range: 35–69). Among the patients, 147 (69.3%) were between 35 and 50 years old, and 160 (75.5%) had style c or d breasts according to the BI-RADS® 5th edition categories (

Discussion

This study demonstrated a useful method for distinguishing abnormalities from breast parenchyma tissues and for diagnosing small breast cancers without enhancement or with contrast-enhanced BCBCT using a high-resolution flat-panel detector and a 3D reconstruction system.

The similar sensitivities observed in the MG and US groups might be due to a bias, as calcifications were the most specific characteristic presented in this study. In several patients, calcifications not categorized as masses or

Conclusion

This preliminary study showed that BCBCT might eliminate the need for compression and additional workup views that are routinely used with MG. Furthermore, the combination of BCBCT and CE-BCBCT was proved superior to MG or/and US for detecting small lesions and distinguish breast cancer during style c and d breasts. BCBCT or/and CE-BCBCT also improved the interpretation of lesions found in other imaging techniques (such as ultrasound) but did not replace these modalities.

Conflict of interest

The authors declare that they have no conflicts of interest concerning this article.

Acknowledgments

The authors acknowledge Chunyan Zhou, MS, ShaoHua Liu, PhD and Xiahua Zhang, PhD for their support. This work was supported by research grant No. 30973418 from the National Natural Science Foundation of China, research grant No. S2012010009103 from the National Natural Science Foundation of Guangdong Province of China and research grant No. 2010B050700025 from the Department of Science and Technology of Guangdong Province, China.

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