Fokal Asimetrik Meme Dansitelerinin Değerlendirilmesinde Tomosentezin Tanıya Katkısı

Yıl 2023, , 108 - 112, 20.01.2023

Derya Güçlü , İbrahim Feyyaz Naldemir , Elif Nisa Unlu , Ömer Önbaş

https://doi.org/10.33631/sabd.1206514

Öz

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.

Anahtar Kelimeler

Dijital mamografi, Tomosentez, Fokal asimetrik dansite

Destekleyen Kurum

Düzce Üniversitesi Bilimsel Araştırma Projeleri

Proje Numarası

2019.04.03.1041

Contribution of Tomosynthesis on the Evaluation of Focal Asymmetrical Breast Densities

Öz

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.

Anahtar Kelimeler

Digital mammography, Tomosynthesis, Focal asimetrical density

Proje Numarası

2019.04.03.1041

Kaynakça

• Breast Cancer [Internet]. 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/breast-cancer
• Menhas R, Umer S. Breast Cancer among Pakistani Women. Iran J Public Health. 2015; 44(4): 586-7.
• Joseph S, Singh E. Nuclear Medicine PET/CT Breast Cancer Assessment, Protocols, And Interpretation. In Treasure Island (FL); 2022.
• Waheed H, Masroor I, Afzal S, Alvi MI, Jahanzeb S. Digital breast tomosynthesis versus additional diagnostic mammographic views for the evaluation of asymmetric mammographic densities. Cureus. 2020; 12(8): e9637.
• Kiarashi N, Samei E. Digital breast tomosynthesis: A concise overview. Imaging Med. 2013; 5(5): 467-76.
• Radiology AC of, D’Orsi CJ. ACR BI-RADS Atlas: Breast ımaging reporting and data system: 2013. American College of Radiology; 2018.
• Chesebro AL, Winkler NS, Birdwell RL, Giess CS. Developing asymmetry at mammography: Correlation with US and MR ımaging and histopathologic findings. Radiology. 2016; 279(2): 385-94.
• Andersson I, Ikeda DM, Zackrisson S, Ruschin M, Svahn T, Timberg P, et al. Breast tomosynthesis and digital mammography: a comparison of breast cancer visibility and BIRADS classification in a population of cancers with subtle mammographic findings. Eur Radiol. 2008;18(12):2817–25. https://doi.org/10.1007/s00330-008-1076-9
• Teertstra HJ, Loo CE, van den Bosch MAAJ, van Tinteren H, Rutgers EJT, Muller SH, et al. Breast tomosynthesis in clinical practice: initial results. Eur Radiol. 2010; 20(1): 16-24.
• Chesebro AL, Winkler NS, Birdwell RL, Giess CS. Developing asymmetries at mammography: A multimodality approach to assessment and management. radiographic. 2016; 36(2): 322-34. https://doi.org/10.1148/rg.2016150123
• Chong A, Weinstein SP, McDonald ES, Conant EF. Digital breast tomosynthesis: concepts and clinical practice. Radiology. 2019; 292(1): 1-14.
• Seo N, Kim HH, Shin HJ, Cha JH, Kim H, Moon JH, et al. Digital breast tomosynthesis versus full-field digital mammography: comparison of the accuracy of lesion measurement and characterization using specimens. Acta Radiol. 2014; 55(6): 661-7.
• Zuley ML, Bandos AI, Ganott MA, Sumkin JH, Kelly AE, Catullo VJ, et al. Digital breast tomosynthesis versus supplemental diagnostic mammographic views for evaluation of noncalcified breast lesions. Radiology. 2013; 266(1): 89-95.
• Yamamoto N, Yoshizako T, Yoshida R, Ando S, Nakamura M, Yoshikawa K, et al. Usefulness of digital breast tomosynthesis for non-calcified benign breast masses. Clin Imaging. 2019; 54: 84-90.
• Lee AHS. Why is carcinoma of the breast more frequent in the upper outer quadrant? A case series based on needle core biopsy diagnoses. Breast. 2005; 14(2): 151-2.
• Chan S, Chen J-H, Li S, Chang R, Yeh D-C, Chang R-F, et al. Evaluation of the association between quantitative mammographic density and breast cancer occurred in different quadrants. BMC Cancer. 2017; 17(1): 274. https://doi.org/10.1186/s12885-017-3270-0
• Seo M, Chang JM, Kim SA, Kim WH, Lim JH, Lee SH, et al. Addition of digital breast tomosynthesis to full-field digital mammography in the diagnostic setting: Additional value and cancer detectability. J Breast Cancer. 2016; 19(4): 438-46.
• Cho KR, Seo BK, Kim CH, Whang KW, Kim YH, Kim BH, et al. Non-calcified ductal carcinoma in situ: ultrasound and mammographic findings correlated with histological findings. Yonsei Med J. 2008; 49(1): 103-10.
• Skaane P. Breast cancer screening with digital breast tomosynthesis. Breast Cancer. 2017; 24(1): 32-41.