Calcifications at Digital Breast Tomosynthesis: Imaging Features and Biopsy Techniques

Area of Science:

• Radiology
• Medical Imaging
• Breast Cancer Screening

Background:

• Full-field digital mammography (FFDM) is standard but has limitations.
• Digital breast tomosynthesis (DBT) offers improved recall and cancer detection rates by reducing tissue overlap.
• Some cancers, especially those with calcifications, may be missed with DBT alone.

Purpose of the Study:

• To review the imaging appearance of breast calcifications at DBT.
• To discuss DBT-guided biopsy techniques.
• To provide an overview of current literature on DBT for breast calcifications.

Main Methods:

• Review of imaging appearance of breast calcifications at DBT.
• Discussion of DBT-guided biopsy techniques.
• Overview of existing literature on DBT and calcifications.

Main Results:

• DBT reduces tissue overlap, improving cancer detection.
• Calcifications can be less conspicuous or missed on DBT compared to FFDM.
• Synthesized mammography (SM) from DBT improves calcification visibility and sensitivity.
• DBT plus SM shows better performance than FFDM alone, but missed cancers are reported.
• DBT-guided biopsy may offer higher success rates and shorter procedure times than stereotactic biopsy.

Conclusions:

• DBT offers significant advancements in breast cancer imaging.
• Awareness of DBT's strengths and limitations, particularly with calcifications, is crucial.
• Combined FFDM and DBT protocols are used, but increase radiation exposure.
• Synthesized mammography (SM) may replace FFDM, reducing radiation, but vigilance for missed calcifications is needed.