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When there are equivocal findings with digital breast tomosynthesis (DBT), spot compression views may significantly enhance specificity and accuracy, and could reduce additional workup in benign cases.
Emerging research suggests the use of additional spot compression views may provide significant clarity to otherwise ambiguous findings with digital breast tomosynthesis (DBT) and curtail the need for additional imaging in ultimately benign cases.
The retrospective study, recently published in the American Journal of Roentgenology, involved 102 women with a mean age of 60, all of whom had a DBT spot compression view to help clarify inconclusive findings on DBT alone. One breast imaging fellow and two fellowship-training breast radiologists reviewed the exams, according to the study. In addition to increased intra-reader and inter-reader agreements, the study authors found that the use of DBT spot compression views resulted in a 16 to 23 percent increase in accuracy and a 19 to 25 percent increase in specificity across the three reviewers.
“ … The DBT spot compression view resulted in significantly improved diagnostic accuracy among three readers of varying levels of experience in breast imaging and DBT,” wrote Foucauld Chamming’s, MD, PhD, who is affiliated with the Department of Radiology at Institute Bergonie in Bordeaux, France, and colleagues. “The DBT spot compression views also resulted in improved intraobserver agreement, improved interreader agreement, and significantly improved confidence among all readers. … The results support the utility of spot compression views for aiding evaluation of subtle or ambiguous findings encountered on DBT in clinical practice.”
The study authors also noted that the use of DBT spot compression views resulted in the downgrading of multiple lesions that were originally diagnosed as BI-RADS category > 4a and BI-RADS category 3 with DBT alone.
“By allowing many more findings to be assessed as BI-RADS category 2, our findings show a role for the DBT spot compression view to reduce unnecessary follow-ups (with additional costs) as well as biopsies of benign lesions,” emphasized the authors in the study.
The authors noted that DBT spot compression views lead to a 27 percent increase in sensitivity for one of the examiners but no significant change in sensitivity for the other two examiners. They acknowledged that DBT spot compression views had an increased radiation dose (1.97 mGy) in comparison to a radiation dose range of 1.78 to 1.81 mGy for craniocaudal and mediolateral oblique DBT views but explained that the additional dosing was below the recommended maximum dose.
Conceding imitations to the study, the authors acknowledged a small sample size, the findings coming from a single tertiary cancer center, and a lack of comparison between DBT spot compression views and spot compression views from digital mammography.