Presentation and Presenting Images
A 42-year-old female presents for screening mammography.
62.2 Key Images
62.2.1 Breast Tissue Density
The breasts are heterogeneously dense, which may obscure small masses.
62.2.2 Imaging Findings
The patient had a conventional digital screening mammogram. In the lower inner quadrant of the left breast, there is a possible focal asymmetry ( Fig. 62.3 and
Fig. 62.4).
62.3 BI-RADS Classification and Action
Category 0: Mammography: Incomplete. Need additional imaging evaluation and/or prior mammograms for comparison.
62.4 Diagnostic Images
( Fig. 62.5,
Fig. 62.6,
Fig. 62.7)
62.4.1 Imaging Findings
The diagnostic imaging demonstrates a possible persistent asymmetry on the craniocaudal (CC) spot-compression mammogram ( Fig. 62.5). The mediolateral oblique (MLO) spot-compression (
Fig. 62.6) and medioateral (ML) mammograms (
Fig. 62.7) are less suggestive of a true asymmetry. The corresponding CC and MLO digital breast tomosynthesis (DBT) movies demonstrate that the focal asymmetry seen on screening mammography is a summation artifact created by overlapping tissues in the same imaging plane.
62.5 BI-RADS Classification and Action
Category 1: Negative
62.6 Differential Diagnosis
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Summation artifact (superimposition of breast tissue): The DBT movies obtained at the diagnostic evaluation best demonstrated that this asymmetry is created by overlapping tissue.
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Radial scar: Subtle asymmetries can represent a radial scar. The DBT images did not support any underlying architectural distortion or other suspicious findings.
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Carcinoma: Carcinomas can initially present as subtle findings, especially lobular carcinoma. It is reassuring that the DBT images revealed overlapping tissue.
62.7 Essential Facts
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Many screening mammograms are recalled for summation artifacts.
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DBT is designed to reduce the summation effects of overlapping tissues and improve lesion conspicuity.
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DBT makes suspicious findings more apparent and helps the reader to recognize normal structures more clearly.
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In DBT the reconstruction of the three-dimensional breast image into slices helps to uncover those areas of overlapping tissue.
62.8 Management and Digital Breast Tomosynthesis Principles
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DBT has demonstrated a reduction in recall rate from 7 to 15% in clinical studies.
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Improvements in sensitivity and specificity are seen on DBT irrespective of breast tissue density.
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DBT is approved for screening and diagnostic mammography imaging. The role in breast imaging is evolving.
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Drawbacks to DBT are the increased radiation for combination exams (FFDM and DBT) and the increased time for reading a study (reported as twice the time).
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DBT produces extremely large data files that require extra PACS (picture archiving and communication system) storage capacity.
62.9 Further Reading
[1] Brandt KR, Craig DA, Hoskins TL, et al. Can digital breast tomosynthesis replace conventional diagnostic mammography views for screening recalls without calcifications? A comparison study in a simulated clinical setting. AJR Am J Roentgenol. 2013; 200(2): 291‐298 PubMed
Fig. 62.1 Left craniocaudal (LCC) mammogram.

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