Tomosynthesis in the Diagnostic Setting: Changing Rates of BI-RADS Final Assessment over Time

Area of Science:

• Radiology
• Medical Imaging
• Oncology

Background:

• Diagnostic mammography is crucial for breast cancer screening and diagnosis.
• The Breast Imaging Reporting and Data System (BI-RADS) provides standardized assessment categories.
• Evaluating new imaging technologies' impact on diagnostic workflows is essential.

Purpose of the Study:

• To assess how the implementation of digital breast tomosynthesis (DBT) affects BI-RADS final assessment categories in diagnostic mammography.
• To analyze changes in BI-RADS categories over time after DBT adoption.
• To compare the positive predictive value of biopsy recommendations (PPV3) between 2D mammography and DBT.

Main Methods:

• Retrospective analysis of diagnostic mammograms before (2D) and after (DBT) technology implementation.
• Comparison of BI-RADS categories 1-5 rates between 2D and DBT groups.
• Evaluation of mammographic features for BI-RADS categories 3, 4, and 5.
• Statistical analysis using chi-squared tests and multivariate logistic regression.

Main Results:

• Tomosynthesis use led to a significant increase in negative or benign assessments (BI-RADS 1 or 2) over three years (58.7% to 75.8%).
• A significant decrease in probably benign assessments (BI-RADS 3) was observed (33.3% to 16.4%).
• While BI-RADS 4 or 5 rates remained stable, the positive predictive value for biopsy (PPV3) significantly improved (29.6% to 50%).

Conclusions:

• Digital breast tomosynthesis implementation in diagnostic settings caused progressive shifts in BI-RADS categories.
• DBT increased the proportion of normal/benign findings and decreased probably benign assessments.
• The study demonstrated improved diagnostic confidence and accuracy for biopsy recommendations with tomosynthesis.