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Scientific Session 03 — Breast - Digital Breast Tomosythesis

Monday, May 1, 2017

Abstracts 1108-2863

2687. Conspicuity of Screen-Detected Cancers on 2D Synthetic Mammography vs Full Field Digital Mammography

Chikarmane S*,  Ratanaprasatporn L,  Yeh E,  Catherine G. Brigham and Women's Hospital, Boston, MA

Address correspondence to L. Ratanaprasatporn (

Objective: The purpose of our study was to evaluate the conspicuity of screen-detected cancers on 2D synthetic mammography (SM) reconstructed from digital breast tomosynthesis (DBT) compared with 2D full field digital mammography (FFDM).

Materials and Methods: Institutional review board–approved retrospective review of consecutive screening-detected cancers from October 30, 2015, to June 30, 2016, was performed. All examinations were rereviewed by three radiologists in consensus (n = 79); a score of 1, 2, or 3 was given to each screening-detected cancer on SM versus FFDM (1 = FFDM more conspicuous than SM, 2 = FFDM equivalent to SM, and 3 = SM more conspicuous than FFDM). Findings considered only visible on tomosynthesis were excluded. The dominant finding for each patient was recorded and classified as mass, calcifications, architectural distortion, focal asymmetry or asymmetry, or other. The longitudinal medical record was reviewed to determine patient demographics and outcomes of imaging surveillance and biopsy.

Results: Seventy-nine screening-detected cancers in 79 women were detected during the study period (mean age, 59.7 years, range, 28–94 years). Of these, 11 were considered tomosynthesis-only findings and therefore excluded. Morphology (n = 68) included masses (n = 34, 50%), calcifications (n = 20, 29.4%), asymmetry (n = 9, 13.2%), distortion (n = 4, 5.9%), and other (skin thickening) (n = 1, 1.5%). Consensus conspicuity scores were masses = 2.5, calcifications = 2.5, asymmetries = 2.5, distortion = 3, and other = 2. Masses and asymmetries were more often less conspicuous on SM than FFDM when compared with calcifications. Patient factors including menopausal status, family or personal history of breast cancer, BRCA status, and breast density did not influence conspicuity scores.

Conclusion: Conspicuity of screening-detected cancers are equal to more conspicuous on SM when compared with FFDM when controlling for breast density and other patient factors. To reduce radiation doses, SM and DBT may be a reasonable alternative to FFDM and DBT in breast cancer screening, with understanding that cancers presenting as asymmetries and masses may sometimes be less conspicuous on SM than on FFDM.