A comparison of full-field digital mammography (FFDM) with digital breast tomosynthesis (DBT) in the detection of microcalcifications by correlating mammographic and pathologic findings

Introduction: Breast micro-calcifications primarily represent benign conditions; they might be regarded as the earliest presentations of malignancies. As a well-known procedure, full-field digital mammography (FFDM) is a 2-dimensional (2-D) imaging modality most frequently used in breast cancer screening. DBT, i.e., digital breast tomosynthesis, on the other hand, is a 3- 3-dimensional (3-D) modality increasingly attracting the attention of researchers in the field for clinical applications. Objectives: The present study compares FFDM values against DBT technique data- considered a valuable means of screening breast cancers. Patients and Methods: This is a cross-sectional study conducted on 92 suspected breast cancer patients who underwent screening assessments using both FFDM and DBT. The breast calcification and density categories were identified according to ACR BI-RADS (American College of Radiology Breast Imaging- Reporting and Data System). The calcifications were categorized as benign (BIRADS 2 and 3) or malignant (BIRADS 4 and 5). The histopathological findings from the biopsied lesions were considered the gold standard for breast cancer diagnosis. The outcomes of FFDM and DBT were compared. Results: The total sensitivity of DBT in identifying benign versus malignant lesions was 96.7%. In the case of FFMD, the sensitivity value was 90.2%. On the other hand, both modalities revealed similar specificity, accounting for 8.7%. The area under the curve (AUC) accounted for 0.527 for DBT and 0.505 for FFDM. The overall agreement coefficient for the two radiologists in the identification of micro-calcifications accounted for 0.613 (95% CI: 0.394-0.823). This agreement coefficient for FFDM was 0.676 (95% CI: 0.412, 0.940), and the value for the DBT procedure was 0.517 (95% CI: 0.147, 0.887). Conclusion: According to the current study, DBT can be considered a powerful tool in screening and diagnosing microcalcifications such as FFDM in breast tissue. Although the sensitivity of DBT is remarkably high, its specificity is not justifiable.