Diagnostic performance of tomosynthesis, digital mammography and a dedicated digital specimen radiography system versus pathological assessment of excised breast lesions

Almasarweh, Sa’ed; Sudah, Mazen; Okuma, Hidemi; Joukainen, Sarianna; Kärjä, Vesa; Vanninen, Ritva; Masarwah, Amro

Diagnostic performance of tomosynthesis, digital mammography and a dedicated digital specimen radiography system versus pathological assessment of excised breast lesions

Radiology and Oncology

Volume 56 (2022): Issue 4 (December 2022)

By:

Sa’ed Almasarweh, Mazen Sudah, Hidemi Okuma, Sarianna Joukainen, Vesa Kärjä, Ritva Vanninen and Amro Masarwah

Open Access

|Oct 2022

Figures & Tables

Specimen radiographs of a spiculated invasive ductal carcinoma excised after ultrasound guidewire localisation. The tumour and spicules are clearly visible in all three imaging modalities (closed arrows). (A) Specimen radiography system, (B) full-field digital mammography and (C) tomosynthesis (1 mm reconstructed image at the level of the tumour). Metal clips indicate the anatomical position (open arrows; 1 clip-lateral and 2 clips-medial). The position of the specimen is constant in all three imaging modalities.

A 44-year-old female presented with a 5 × 4.5 cm multifocal invasive lobular carcinoma and underwent supine magnetic resonance imaging-guided oncoplastic conservative resection. Although the irregular area of the tumour (thick arrows) is visible on the specimen radiography system (A) and full-field digital mammography (B) images, the tumour margins are best delineated by tomosynthesis (C) (1 mm reconstructed image at the level of the tumour). The pleomorphic lobular carcinoma in situ is clearly depicted by tomosynthesis as an area of linear calcifications (thin arrows). The shortest margins at imaging were 4 mm (open arrow; superior) and 5 mm at final pathology. The fascia at the level of tumour was removed separately (dotted arrow).

A 68-year-old female presented with invasive ductal carcinoma, papillary ductal carcinoma in situ, and papillomatosis, and underwent oncoplastic conservative breast resection. (A) Shows the excised skin area above the tumour that was deemed not visible by both observers on the specimen radiography system image (B). (C) Full-field digital mammography shows a small oval lesion (arrow). (D) Tomosynthesis (1 mm reconstructed image) shows the full extension of the large spiculated area (arrows).

Bland-Altman plots of tumour diameters compared with the pathological report, as measured by observer 1 (A–C) and observer 2 (D–F) using tomosynthesis (A,D), specimen radiography system (B,E), and full-field digital mammography (C,F).

Characteristics of the patients, surgical procedures and tumours

Mean age years (range)	62.5 (33−95)
Mammography negative	20 (9.3%)
Surgery
Wide local excision	158 (73.1%)
Oncoplastic	58 (26.9%)
Specimen diameter (mm)
Mean	97.65
Median	89.0
Range	25–285
Histology n (%)
Invasive ductal	120 (55.6%)
Invasive lobular	27 (12.5%)
Mixed malignant	7 (3.2%)
Pure DCIS	26 (12.0%)
Other malignant	11 (5.1%)
Benign	25 (11.6%)
Size of tumour mean mm (range)	15.69 (0–70)
Presence of DCIS	114 (52.8%)
Grade
1	62 (28.7%)
2	94 (43.5%)
3	35 (16.2%)
T-stage
Tis	27 (14.1%)
T1	122 (63.9%)
T2	40 (20.9%)
T3	2 (1.0%)
N-Stage
N0	145 (75.9%)
N1	39 (20.4%)
N2	6 (3.1%)
N3	1 (0.5%)
ER-Status
Positive	152 (92.2%)
Negative	13 (7.8%)
PR-Status
Positive	147 (89.2%)
Negative	18 (10.8%)
HER2-Status
Positive	12 (7.3%)
Negative	153 (92.7)

Evaluated parameters of the specimen with three different imaging modalities by both observers

Margins	> 10mm		6–10		≤ 5mm
Observer	1	2	1	2	1	2
Tomosynthesis	156	114	20	37	19	49
SRS	132	126	15	15	8	23
FFDM	158	135	14	38	13	28
Diagnostic Certainty	Not at all		Somehow Certain		Average		Almost Certain		Completely Certain
Observer	1	2	1	2	1	2	1	2	1	2
Tomosynthesis	21	19	12	6	15	22	40	46	128	123
SRS	61	53	21	12	22	26	59	40	53	85
FFDM	32	23	13	19	18	34	61	53	92	87
Lesion Visibility	0%		0−10%		10−50%		50−90%		90−100%
Observer	1	2	1	2	1	2	1	2	1	2
Tomosynthesis	22	16	15	18	13	24	34	40	132	118
SRS	60	50	20	51	26	50	65	35	45	30
FFDM	32	21	15	27	18	40	57	60	94	68
Spiculation visibility	Not visible		Partially visible		Completely visible		No spiculations
Observer	1	2	1	2	1	2	1	2
Tomosynthesis	1	8	23	30	45	103	147	75
SRS	11	32	43	68	3	5	159	111
FFDM	5	31	54	67	9	42	148	76
Calcifications	Present		Less visible		Equally visible		More visible
Observer	1	2	1	2	1	2	1	2
Tomosynthesis	48	53	4	13	25	30	19	10
SRS	47	41	40	30	7	9	0	2
FFDM	49	53	18	28	28	21	3	4

Mammographic features and lesion descriptors according to the Breast Imaging Reporting and Data System, 5th Edition

Breast density
A	57	B	121	C	34	D	4
Peritumoral density %
< 25%	90	25%–50%	20	50%–75%	24	75%–100%	60
Mass Shape
Oval	17	Round	70	Irregular	58
Mass Margin
Circumscribed	4	Obscured	7	Microlobulated	36
Indistinct	27	Spiculated	71
Calcifications
Amorphous		2		Fine Pleomorphic		42
Coarse Heterogenous		2		Fine linear or branching		7
Calcification distribution
Regional		9		Linear		6
Grouped		33		Segmental		5
Architectural Distortion
Yes		15		No		201

Diameters of the excised lesions evaluated by the two observers using three imaging modalities and in the final pathology report

Lesion diameter	Mean (mm)	Median (mm)	Minimum (mm)	Maximum (mm)	Pearson’s coefficient (r)
Observer 1
Tomosynthesis	16.82	12.70	2.90	84.10	0.471
SRS	17.45	13.90	2.10	96.90	0.421
FFDM	16.96	12.60	2.00	90.10	0.452
Observer 2
Tomosynthesis	23.04	19.00	4.00	88.00	0.614
SRS	21.31	17.00	5.00	97.00	0.457
FFDM	20.21	15.00	3.00	95.00	0.550
Final Pathology
	15.69	14.00	0	70

The preferred imaging modalities for individual lesions selected by the two observers

	Observer 1	Observer 2
Tomosynthesis	166 (76.9%)	166 (76.9%)
SRS	1 (0.5%)	6 (2.8%)
FFDM	21 (9.7%)	14 (6.5%)
All equal	5 (2.3%)	12 (5.6%)
None	23 (10.6%)	18 (8.3%)

DOI: https://doi.org/10.2478/raon-2022-0036 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099

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Language: English

Page range: 461 - 470

Submitted on: May 23, 2022

Accepted on: Jul 6, 2022

Published on: Oct 13, 2022

Published by: Association of Radiology and Oncology

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

breast cancer,

radiography,

digital breast tomosynthesis,

surgery,

Related subjects:

Haematology, oncology,

Radiology

© 2022 Sa’ed Almasarweh, Mazen Sudah, Hidemi Okuma, Sarianna Joukainen, Vesa Kärjä, Ritva Vanninen, Amro Masarwah, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.

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Diagnostic performance of tomosynthesis, digital mammography and a dedicated digital specimen radiography system versus pathological assessment of excised breast lesions

Figures & Tables

Figure 1

Figure 2

Figure 3

Figure 4

Characteristics of the patients, surgical procedures and tumours

Evaluated parameters of the specimen with three different imaging modalities by both observers

Mammographic features and lesion descriptors according to the Breast Imaging Reporting and Data System, 5th Edition

Diameters of the excised lesions evaluated by the two observers using three imaging modalities and in the final pathology report

The preferred imaging modalities for individual lesions selected by the two observers

Paradigm

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