Spot Compression Tomosynthesis: Utility in the Workup of Focal Pain and Palpable Abnormalities

To evaluate whether spot compression digital breast tomosynthesis (scDBT) adds diagnostic value beyond standard full-field digital breast tomosynthesis (FFDBT) in patients presenting with focal breast pain or palpable abnormalities.

In this retrospective cohort study, we identified 196 women aged ≥30 years who underwent FFDBT, scDBT, and targeted ultrasound for focal breast pain (n = 112) or palpable findings (n = 110) over a 5-year period, with ≥2 years of follow-up. Three fellowship-trained breast imaging radiologists independently interpreted FFDBT and scDBT views in separate sessions with a 4-week washout period. Imaging findings, BI-RADS assessments, pathology results, and correlation with clinical outcomes were analyzed to compare diagnostic performance.

In the focal pain cohort, image-detected abnormalities were rare (3.6%), and agreement regarding the presence or absence of an imaging finding was high for both FFDBT (85.1%) and scDBT (80.1%, P = 0.08). No cancers or high-risk lesions were detected. Among patients with palpable findings, abnormal imaging findings were more common (41.8%), but agreement did not significantly differ between FFDBT (63.0%) and scDBT (69.4%, P = 0.08). Most actionable findings were visible on FFDBT or ultrasound, with a substantial proportion identified on ultrasound only. scDBT did not detect any malignant or high-risk lesions not already identified on FFDBT or ultrasound.

Our study found no significant difference in reader performance using scDBT compared to standard FFDBT in the workup of focal breast pain or palpable abnormalities. Based on these results, eliminating routine scDBT views for these diagnostic imaging protocols may improve workflow and reduce radiation exposure without compromising diagnostic performance.