Figure 1
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.
Figure 2
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).
Table 1
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) |
Table 2
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 | ||||
Table 3
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%) |
Figure 3
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).
Table 4
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 | ||
Figure 4
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).
Table 5
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 |