Digital Breast Tomosynthesis—Imaging and Biopsy of Calcifications

The digital breast tomosynthesis imaging appearance of breast calcifications is reviewed and biopsy techniques of calcifications are discussed.

Course ID: Q00598 Category:
Modality:

2.5

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Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:

Mammography: 2.50
Image Production: 0.75
Image Acquisition and Quality Assurance: 0.75
Procedures: 1.75
Anatomy, Physiology, and Pathology: 1.00
Mammographic Positioning, Special Needs, and Imaging Procedures: 0.75

Outline

  1. Introduction
  2. DBT and Synthesized Mammography
  3. DBT for Screening
    1. Screening Protocols
  4. Diagnostic Performance of DBT in the Detection of Breast Cancer
  5. Calcifications and Breast Cancer
  6. Types of Breast Calcifications
    1. Benign Calcifications
    2. Probably Benign Calcifications
    3. Suspicious Calcifications
    4. Distribution
  7. Calcification Artifacts at DBT
  8. Clinical Performance of DBT in the Detection of Breast Calcifications
    1. DBT versus FFDM
    2. DBT Plus FFDM versus FFDM Alone
    3. SM versus FFDM
    4. Calcification Conspicuity
  9. DBT-guided Biopsy
  10. Future Directions for DBT
  11. Conclusion

Objectives

Upon completion of this course, students will:

  1. state the cancer mortality reduction percentage achieved with screening mammography
  2. list the patients best served by FFDM
  3. explain the advantages of DBT over FFDM
  4. describe how the x-ray tube moves in DBT
  5. compare radiation dose protocols between DBT and FFDM
  6. recall the factors that affect the range of breast radiation dose at DBT
  7. state what synthesized mammograms are created from
  8. compare the approximate reduction in radiation does that is observed with DBT plus synthesized mammography as compared to DBT plus FFDM
  9. describe how DBT for breast cancer screening improves sensitivity and specificity over the use of FFDM
  10. compare screening protocols for DBT plus FFDM versus DBT alone
  11. discuss the combined techniques for increasing sensitivity and specificity of breast cancer screening
  12. list the screening trials that compare the use of DBT combined with FFDM to the use of FFDM alone
  13. list how invasive and in situ breast cancers can manifest
  14. describe how calcification morphology is classified
  15. describe how benign calcifications are seen at mammography
  16. know the BI-RADS category for benign calcifications
  17. describe the appearance of skin calcifications
  18. recognize typically benign versus suspicious morphology related to breast calcifications
  19. describe the appearance of vascular calcifications
  20. describe rim calcifications
  21. recall how lesions with a less than 2 percent likelihood of malignancy are classified
  22. state the interval follow-up for calcifications detected at baseline screening mammography that have a probably benign appearance
  23. list the morphologic descriptions for suspicious calcifications
  24. list how calcification distribution can be described
  25. describe artifacts most frequently related to calcifications
  26. recall how shadow artifacts appear on synthesized mammograms
  27. choose the study that included 99 cases of malignant calcifications in order to compare their detection between DBT and FFDM
  28. state which trial had similar sensitivities when comparing digital breast imaging plus FFDM with FFDM alone in the detection of malignant calcifications
  29. give the performance percentage of DBT plus synthesized mammography in the detection of malignant calcifications as seen in the TOMMY trial
  30. list the factors that may cause lower spatial resolution at DBT
  31. compare the pros and cons of the use of DBT for diagnosing breast calcifications
  32. list the challenges of stereotactic biopsy
  33. discuss why conventional stereotactic breast biopsy is still needed
  34. describe patient position for DBT-guided breast biopsy
  35. choose which trial will compare DBT and FFDM screening protocols with the objective of determining which is the best screening modality