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The role of cone-beam breast-CT for breast cancer detection relative to breast density

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Abstract

Objectives

To evaluate the impact of breast density on the diagnostic accuracy of non-contrast cone-beam breast computed tomography (CBBCT) in comparison to mammography for the detection of breast masses.

Methods

A retrospective study was conducted from August 2015 to July 2016. Fifty-nine patients (65 breasts, 112 lesions) with BI-RADS, 5th edition 4 or 5 assessment in mammography and/or ultrasound of the breast received an additional non-contrast CBBCT. Independent double blind reading by two radiologists was performed for mammography and CBBCT imaging. Sensitivity, specificity and AUC were compared between the modalities.

Results

Breast lesions were histologically examined in 85 of 112 lesions (76%). The overall sensitivity for CBBCT (reader 1: 91%, reader 2: 88%) was higher than in mammography (both: 68%, p<0.001), and also for the high-density group (p<0.05). The specificity and AUC was higher for mammography in comparison to CBBCT (p<0.05 and p<0.001). The interobserver agreement (ICC) between the readers was 90% (95% CI: 86-93%) for mammography and 87% (95% CI: 82-91%) for CBBCT.

Conclusions

Compared with two-view mammography, non-contrast CBBCT has higher sensitivity, lower specificity, and lower AUC for breast mass detection in both high and low density breasts.

Key Points

Overall sensitivity for non-contrast CBBCT ranged between 88%-91%.

Sensitivity was higher for CBBCT than mammography in both density types (p<0.001).

Specificity was higher for mammography than CBBCT in both density types (p<0.05).

AUC was larger for mammography than CBBCT in both density types (p<0.001).

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Abbreviations

CBBCT:

Cone-beam breast computed tomography

US:

Ultrasound

MRI:

Magnet resonance imaging

HU:

Hounsfield units

BI-RADS:

Breast Imaging Reporting and Data System

ACR:

American College of Radiology

MHz:

Megahertz

ROI:

Region of interest

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Acknowledgements

The authors acknowledge the team of the Diagnostic Breast Center Göttingen, Germany for their continuous and excellent support.

The preliminary data from this study from Wienbeck S. et al. have been presented at the European Congress of Radiology in Vienna, on 2 March 2016 (Scientific Session SS 302, B-0218).

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Susanne Wienbeck.

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Guarantor

The scientific guarantor of this publication is Prof. Dr. Joachim Lotz, MD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Funding

The authors state that this work has not received any funding.

Statistics and biometry

PD Dr. Antonia Zapf, PhD and Dr. Johannes Uhlig, MD MPH kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational study

• performed at one institution

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Wienbeck, S., Uhlig, J., Luftner-Nagel, S. et al. The role of cone-beam breast-CT for breast cancer detection relative to breast density. Eur Radiol 27, 5185–5195 (2017). https://doi.org/10.1007/s00330-017-4911-z

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  • DOI: https://doi.org/10.1007/s00330-017-4911-z

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