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Subject Area

Radiodiagnosis

Article Type

Original Study

Abstract

Background: Breast lesions range from benign to malignant, with early detection critical for management. Digital mammography is the standard screening tool but may be limited in dense breasts. Ultrasound (US) aids lesion characterisation, while digital breast tomosynthesis (DBT) reduces tissue overlap, enhancing lesion detection.

Objective: To evaluate the diagnostic performance of digital breast tomosynthesis in the characterisation of breast lesions compared with sono-mammography, using histopathology as the reference standard.

Methods: This prospective study included 33 symptomatic female patients with a mean age (45.4 ± 8.2 years) who presented with symptoms such as palpable breast lumps, Mastalgia and nipple discharge between May 2023 and December 2024 at woman imaging unit, diagnostic radiology department, Mansoura university and approved by the Ethics committee of faculty of medicine, Mansoura University. Exclusion criteria included pregnancy, breastfeeding, prior breast surgery, receipt of neoadjuvant chemotherapy, and refusal of consent. All patients underwent clinical assessment, breast ultrasound, digital mammography, and DBT. Lesions were categorised according to American College of Radiology BI-RADS Atlas (2013 edition). Histopathological examination served as the reference standard.

Results: Histopathology revealed 20 benign (60.6%) and 13 malignant (39.4%) lesions. US detected 26 mass lesions (78.8%), Digital mammography 19 (57.6%), and DBT 24 (72.7%). Malignancy was significantly associated with irregular shape, spiculated margins, non-parallel orientation, and high density across all modalities. BI-RADS categorisation showed no significant difference between sono-mammography and DBT. Agreement with histopathology was substantial for sono-mammography (κ = 0.70) and almost perfect for DBT (κ = 0.81). Diagnostic accuracy of DBT (90.9%) and sono-mammography (84.8%) are close to each other, with sensitivity and specificity of 92.3% and 90% for DBT versus 100% and 75% for sono-mammography.

Conclusion: DBT and sono-mammography demonstrated comparable diagnostic accuracy in the evaluation of breast lesions, with each modality offering distinct diagnostic advantages. DBT provided higher specificity and improved lesion characterization, whereas sono-mammography showed excellent sensitivity and remained valuable for differentiating solid from cystic lesions. These finding support the complementary use of both modalities in clinical practice; however, larger prospective studies are needed to confirm these results.

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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