Abstract

Background: The purpose of this study is to assess the role of 3-dimensional breast tomosynthesis in correctly diagnosing breast imaging-reporting and data system (BIRADS) 3 and 0 lesions.

Methods: A prospective study for mammographic cases referred to our radiology unit included 225 patients (out of 1425 patients) who were advised screening mammography during the period from January 2019 to December 2019.

The study was performed in 200 cases, detecting 131 BIRADS 3 and 0 lesions. All mammograms were classified as BIRADS 1–5 category after 3D DBT. All breast lesions that were upgraded by 3D DBT were either aspirated, biopsied, or surgically removed, and were followed-up.

Results: 77.8 % of BIRADS 3 and 0 lesions detected by 2D digital mammography (102/131) changed their category after 3D DBT and 22.2 % (29/131) of digital mammography assigned BIRADS 3 and 0 lesions did not change after 3D DBT.

77.8 % percent of the lesions changed their BIRADS system classification following DBT:

1. 3D DBT upstaged to BIRADS 4 and 5 in 34 lesions representing 15.1 % of the cases.
2. 3D DBT down staged to BIRADS 1 and 2 in 68 lesions representing 51.9 % of the cases.

We performed a biopsy in all suspected findings on tomosynthesis. Of 225 patients, 60 were proven to have malignancy. Of this 60 patients, 46 patients had a single lesion, 6 had multifocal disease, and 8 had multicentric disease.

Conclusion: 3D DBT significantly reduced the need for additional mammographic views and frequent follow-up studies as it gave better characterization for all BIRADS 3 and 0 lesions. 3D DBT did not show any false-negative results in this study and it did not miss any cancers. In addition, reduction in false positive results reduced the stress levels in women. Therefore, 3D digital breast tomosynthesis should be applied in the diagnostic algorithm in patients with mammography detected BIRADS 3 and 0 lesions.

Keywords: BI-RADS classification; Digital mammography; Tomosynthesis.