Additive Role of Digital Tomosynthesis in Detection of Suspicious Mass in Dense Breast

Abstract Background: Breast cancer in women is considered a major public health problem throughout the world. It is the most common cancer among women both in developed and developing countries, accounting for 22.9% of all female cancers. Aim of Study: Our study aimed to compare sensitivity and specificity of DBT and FFDM in detection of BC repre-sented as a mass in women with dense breasts (categories C and D according BI-RADS Atlas) and correlation with his-topathology to confirm superior role of tomosynthesis and it is malignant mass. Patients and Methods: This is across sectional included 30 patients with dense breasts (categories C and D) with suspicious mass (BIRADS category IV, V) on any imaging modality were included. First imaging modality was FFDM followed by DBT and high resolution ultrasound (HHUS) in order to establish correlation with mammographic findings than finally histopathology to confirm diagnosis of cancer. Results: The current study based on Digital mammography as a reference standard, Tomosynthesis detect mass lesions at category C in 11 patients (true positives). Tomosynthesis did not detect mass lesions in 5 patients (true negatives). Ten patients had false negative results. We found that Tomosyn-thesis had overall sensitivity, specificity, and diagnostic accuracy of 52.4%, 100% and 61.5% respectively in detecting the breast mass in our patients. Positive predictive value was 100% while the negative predictive value was 33.3%. Based on Digital mammography as a reference standard, Tomosyn-thesis detect mass lesions at category D in 2 patients (true positives). Tomosynthesis did not detect mass lesions in 2 patients (true negatives). Two patients had false negative results. We found that Tomosynthesis had overall sensitivity of 50% with Positive predictive value was 100%. Based on Digital mammography as a reference standard, Tomosynthesis detect mass lesions at all ACR categories in 13 patients (true positives). Tomosynthesis did not detect mass lesions in 5 patients (true negatives). Twelve patients had false negative results. We found that Tomosynthesis had overall sensitivity, specificity, and diagnostic accuracy of 54.2%, 100% and 62.07% respectively in detecting the breast mass in our patients. Positive predictive value was 100% while the negative predictive value was 31.25%. Our results showed that 100% of lesions detected by tomosynthesis were malignant tumors. 83.3% of lesion detected were invasive ductal carcinoma, 6.7% were invasive lobular carcinoma, 3.3% Inflammatory carcinoma and 6.7% were DCIS. The present study showed that there were high statistically significant differences between digital mammography and tomosynthesis in BIRADS. Conclusion: We concluded that DBT showed higher sensitivity and specificity and diagnostic accuracy than Mam-mography as it allows better detection and characterization of breast lesions with decrease of false positive and negative cases.