Contribution of Tomosynthesis on the Evaluation of Focal Asymmetrical Breast Densities

Abstract

Aim: In this study, it was aimed to investigate the contribution of tomosynthesis to the diagnosis in cases with focal asymmetric density in mammographic examinations and requiring additional examination. Materials and Methods: Tomosynthesis was performed in addition to 56 patients with focal asymmetric breast density in the evaluation of the images of the patients who underwent scanning or diagnostic digital mammography in the Breast Imaging Unit of the Radiology Department of our hospital in February 2020-June 2022, and the findings were classified using BI-RADS. Patient age, breast pattern, breast with focal asymmetic density and its quadrant were recorded. Afterwards, bilateral breast ultrasonography examination was performed as a complementary and gold standard examination, and the findings were recorded. Results: The mean age of 56 female cases who were evaluated as BI-RADS 0 due to focal asymmetric density as a result of digital mammography imaging was 51.5 ± 8.1 years. 12.5% (n=7) type A, 42.9% (n=24) type B, 41.1% (n=23) type C, 3.6% (n=2) have D type breast pattern. 44.6% (n=25) of focal asymmetrical densities were detected in the right breast and 55.4% (n=31) in the left breast. In the evaluation of digital tomosynthesis examinations, 41.1% (n=23) of the cases were classified as BI-RADS 1, 16.1% (n=9) as BI-RADS 2, 21.4% (n=12) as BI-RADS 3, 21.4% (n=12) as BI-RADS 4. In the ultrasonographic examination, 42.9% (n=24) of the patients were evaluated as asymmetric fibroglandular tissue, 17.9% (n=10) as probable benign lesion, and 19.6% (n=11) as malignant lesion. Of the 12 patients for whom histopathological examination was recommended, 2 were evaluated as stromal fibrosis, and the other 10 were evaluated as invasive breast carcinoma, one of which was lobular. Conclusion: This study emphasizes the diagnostic importance of tomosynthesis in focal asymmetric densities whose morphology cannot be evaluated by mammographic examinations and requires additional examination. Tomosynthesis is a relatively new technique that has been increasingly used in the last decade and can solve the diagnostic difficulties in lesions superposed to the parenchyma.

Keywords

• Digital mammography
• Tomosynthesis
• Focal asimetrical density

Fokal Asimetrik Meme Dansitelerinin Değerlendirilmesinde Tomosentezin Tanıya Katkısı

Abstract

Amaç: Bu çalışma ile mamografik incelemelerde fokal asimetrik dansite saptanan ve ek tetkik gerektiren olgularda tomosentezin tanıya katkısını araştırmak amaçlanmıştır. Gereç ve Yöntemler: Hastanemiz Radyoloji Anabilim Dalı Meme Görüntüleme Ünitesine Şubat 2020-Haziran 2022 tarihleri arasında tarama ya da tanısal amaçlı dijital mamografi tetkiki yapılan ve fokal asimetrik meme dansitesi saptanan 56 olguya, ek olarak tomosentez inceleme yapıldı ve bulgular BI-RADS kullanılarak sınıflandırıldı. Hasta yaşı, meme paterni, fokal asimetik dansite bulunan meme ve kadranı kaydedildi. Sonrasında tamamlayıcı ve altın standart tetkik olarak bilateral meme ultrasonografi incelemesi yapılarak bulgular kaydedildi. Bulgular: Dijital mamografi görüntüleme sonucunda fokal asimetrik dansite nedeniyle BI-RADS 0 olarak değerlendirilen 56 kadın olgunun ortalama yaşları 51,5 ± 8,1’dir. %12,5’i (n=7) A tipi, %42,9’u (n=24) B tipi, %41,1’i (n=23) C tipi, %3,6’sı (n=2) D tipi meme paternine sahiptir. Fokal asimetrik dansitelerin % 44,6’sı (n=25) sağ, %55,4’ü (n=31) sol memede saptanmıştır. Dijital tomosentez incelemelerinin değerlendirilmesinde, olguların % 41,1’i (n=23) BI-RADS 1, % 16,1’i (n=9) BI-RADS 2, % 21,4’ü (n=12) BI-RADS 3, 21,4’ü (n=12) BI-RADS 4 olarak sınıflanmıştır. Ultrasonografik incelemede hastaların %42,9’u (n=24) asimetrik fibroglandüler doku, %17,9’u (n=10) olası benign lezyon, % 19,6’sı (n=11) ise malign lezyon olarak değerlendirilmiştir. Histopatolojik inceleme önerilen 12 hastanın ikisi stromal fibrozis, diğer 10’u ise biri lobüler olmak üzere invaziv meme karsinomu olarak değerlendirilmiştir. Sonuç: Bu çalışma mamografik incelemeler ile morfolojisi değerlendirilemeyen ve ek tetkik gerektiren fokal asimetrik dansitelerde tomosentezin tanısal önemini vurgulamaktadır. Tomosentez, son dekatta kullanımı giderek artan ve parankime süperpoze lezyonlarda yaşanabilecek tanı güçlüklerini çözebilecek görece yeni bir tekniktir.

Keywords

• Dijital mamografi
• Tomosentez
• Fokal asimetrik dansite

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