Morphological and Distribution Pattern of Calcifications on Full Field Digital Mammography versus Digital Breast Tomosynthesis and Comparison of Diagnostic Abilities of the Two Modalities: A Retrospective Study

Abstract

Introduction: Microcalcification (MC) is an effective and sometimes the only indicator of breast cancer. Early detection and characterisation of malignant MC can facilitate early diagnosis and timely treatment of breast cancer. However, due to the small size and low contrast as compared to the background parenchyma, it is difficult and time-consuming for radiologists to accurately evaluate MC. Aim: To compare the diagnostic abilities of Full Field Digital Mammography (FFDM) and Digital Breast Tomosynthesis (DBT) in the detection and characterisation of breast calcifications. Materials and Methods: This retrospective descriptive study was conducted in the year 2022 at the breast imaging unit of Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India and data of patients who had undergone FFDM and DBT between March 2019- September 2020 was collected. Mammograms of 702 women with 1217 breasts were evaluated and MC was detected in 622 breasts. Based on the morphology and distribution pattern, Breast Imaging Reporting and Data System (BI-RADS) assessment Category was assigned from 2 to 5. Cases with BI-RADS 2 and 3 were followed-up by repeat Mammograms at 6-month to 1-year intervals. Cases with BI-RADS 4 and 5 were biopsied under stereotactic or ultrasound guidance. Histopathology findings and the stability of the calcifications on sequential mammograms were considered the gold standard for final BI-RADS categorisation. The Chi-square test was applied for the comparison of FFDM and DBT. Results: Typically benign morphology MC was noted in 508 (81.67%) of breasts on FFDM and 505 (80.67%) on DBT. Suspicious morphology MC was noted in 114 (18.33%) of breasts on FFDM and 121 (19.33%) on DBT. Vascular calcification was the most common benign MC seen in 233 cases (37.45%) on FFDM and 244 cases (38.9%) on DBT. Similarly, fine pleomorphic was the most common suspicious morphology MC on FFDM and DBT both seen in 47 cases (7.5%) and 44 cases (7.02%), respectively. The most common distribution pattern was diffuse seen in 582 cases (93.56%) on FFDM and 583 cases (93.13%) on DBT, respectively. No significant difference was observed (p=0.283) in the rate of detection or characterisation of MC by FFDM or DBT. The sensitivity of both modalities were almost similar (97.7% and 97.9%) without any significant difference (p=0.278). Similarly, there was no difference in the specificity (94.9% and 94.4%, respectively, p=0.289). Conclusion: The performance of FFDM and DBT for the detection and characterisation of MC is not significantly different.

Keywords

• calcification
• microcalcification
• bi-rads
• mammogram