Dedicated Cone-beam Breast Computed Tomography and Diagnostic Mammography: Comparison of Radiation Dose, Patient Comfort, And Qualitative Review of Imaging Findings in BI-RADS 4 and 5 Lesions

Avice M O'Connell, Daniel Kawakyu-O'Connor, Avice M O'Connell, Daniel Kawakyu-O'Connor

Abstract

Objective: This pilot study was undertaken to compare radiation dose, relative visibility/conspicuity of biopsy-proven lesions, and relative patient comfort in diagnostic mammography and dedicated cone-beam breast computed tomography (CBBCT) in Breast Imaging-Reporting and Data System (BI-RADS)(®) 4 or 5 lesions.

Materials and methods: Thirty-six consecutive patients (37 breasts) with abnormal mammographic and/or ultrasound categorized as BI-RADS(®) 4 or 5 lesions were evaluated with CBBCT prior to biopsy. Administered radiation dose was calculated for each modality. Mammograms and CBBCT images were compared side-by-side and lesion visibility/conspicuity was qualitatively scored. Histopathology of lesions was reviewed. Patients were administered a survey for qualitative evaluation of comfort between the two modalities.

Results: CBBCT dose was similar to or less than diagnostic mammography, with a mean dose of 9.4 mGy (±3.1 SD) for CBBCT vs. 16.9 mGy (±6.9 SD) for diagnostic mammography in a total of 37 imaged breasts (P<0.001). Thirty-three of 34 mammographic lesions were scored as equally or better visualized in CBBCT relative to diagnostic mammography. Characterization of high-risk lesions was excellent. Patients reported greater comfort in CBBCT imaging relative to mammography.

Conclusion: Our experience of side-by-side comparison of CBBCT and diagnostic mammography in BI-RADS(®) 4 and 5 breast lesions demonstrated a high degree of correlation between the two modalities across a variety of lesion types. Owing to favorable radiation dose profile, excellent visualization of lesions, and qualitative benefits including improved patient comfort, excellent field-of-view, and more anatomical evaluation of lesion margins, CBBCT offers a promising modality for diagnostic evaluation of breast lesions.

Keywords: Breast CT; mammography; radiation dose.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Dose comparison between diagnostic mammography and CBBCT.
Figure 2
Figure 2
A forty-two-year-old woman with palpable lump in upper outer breast. No abnormality was present on mammographical (a) R CC (b) R MLO views (c) biopsy of sonographical mass demonstrated invasive ductal carcinoma. CBBCT demonstrates mass with convex margins arising from glandular tissue in the posterior lateral breast/axilla in both (d) transverse (e) sagittal 1-mm thick sections, which approximate CC and MLO views, respectively.
Figure 3
Figure 3
A fifty-two-year-old woman with developing focal asymmetry in screening mammography. (a) R ML (b)RCC mammographical views of focal asymmetry in 12 o’clock position in the anterior 1/3 of the right breast, which persisted in spot compression views (not shown). CBBCT (c) sagittal (d) transverse views in the expected location do not demonstrate any suspicious lesion. (e) Volume-rendered CBBT image demonstrates no evidence of mammographical lesion in the anterior breast. Stereotactic biopsy demonstrated benign histology (“fibrocystic changes”).
Figure 4
Figure 4
A forty-five-year-old woman with mass on screening mammography with benign features. Diagnostic (a) RCC mammographical view transverse CBBCT 0.27-mm section image demonstrate circumscribed mass in the posterior breast (arrowheads). (c) Three-dimensional reconstruction from same CBBCT data set more clearly delineates lesion, demonstrated to be a fibroadenoma following ultrasound-guided biopsy.
Figure 5
Figure 5
A fifty-five-year-old woman with microcalcifications in screening mammogram. (a) Diagnostic RCC demonstrates clusters of microcalcifications within overlapping glandular tissue. Despite small size, these calcifications are more conspicuous in (b) volume-rendered images at standard 0.27-mm3 resolution. Stereotactic biopsy demonstrated DCIS.
Figure 6
Figure 6
A fifty-eight-year-old woman with mammographical mass in the posterior breast. Diagnostic (a) L CC (b) MLO views with detail of region of interest (inset); CBBCT images in (c) transverse and sagittal (through the d) medial and (e) lateral portions of the lesion, respectively) 3.0-mm sections demonstrate spicules extending from the mass anteriorly (arrowheads, c and e) and additional possible satellite nodules (arrows, d).

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