Biopsies guided by digital breast tomosynthesis (DBT) may offer some practical advantages over digital mammography-guided biopsies, according to research published February 7 in the European Journal of Radiology.
DBT-guided biopsies of suspicious calcifications led to shorter procedure times and reduced radiation exposure compared with mammography-guided biopsies, wrote a team led by Eralda Mema, MD, and colleagues from Weill Cornell Medicine in New York. And both approaches did not significantly differ in malignancy rates.
“This could provide added reassurance to patients concerned about radiation during mammographic-guided procedures and potentially improve future compliance with screening mammography,” the Mema team wrote.
Digital mammography-guided stereotactic biopsy is the conventional approach to sampling suspicious breast calcifications. However, DBT continues to increase in prominence in breast imaging facilities.
Prior studies suggest that DBT-guided biopsies have superior clinical performance for noncalcified lesions, while emerging evidence holds promise for the same advantages for sampling calcified lesions. These studies have also highlighted DBT-guided procedures as being more tolerable for patients.
Mema and colleagues compared the clinical performance and outcomes of DBT- versus digital mammography-guided biopsy of suspicious calcifications. They focused on technical success, procedure time, and exact radiation exposure.
The researchers reviewed 2,200 biopsies and records of 2,126 women who underwent stereotactic biopsies for suspicious calcifications. The women underwent biopsies at a single institution between 2020 and 2023.
Of the total stereotactic biopsies performed during the study period, 1,335 (76%) were performed using mammography guidance, while 421 (24%) were performed using DBT guidance. However, DBT use increased throughout the study period, including from 22% in 2022 to 26% in 2023. In this same period, mammography-guided biopsies decreased from 78% to 74%.
The team also reported shorter average procedure times, fewer exposures, and lower average radiation dose with DBT-guided biopsies. However, malignancy rates remained the same in both groups.
Comparison between DBT- and digital mammography-guided biopsy of breast calcifications | |||
Measure | Mammography guidance | DBT guidance | p-value |
Procedure time | 15 minutes | 14 minutes | < 0.001 |
Exposures | 8.6 | 5.7 | < 0.001 |
Radiation doses | 15 mGy | 13 mGy | 0.005 |
Malignancy rates | 16% | 16% | > 0.05 |
The comparable malignancy rates suggest that both techniques lead to similar diagnostic outcomes, the researchers wrote.
“These benefits make DBT-guided biopsies the preferred method for sampling lesions identified in both [digital mammography] and DBT,” they added.
The results may help guide breast radiologists on whether to transition from digital mammography-guided biopsies to DBT-guided biopsies to sample calcifications, the study authors highlighted.
“Future studies incorporating a multicenter prospective design, standardized biopsy selection criteria, and broader inclusion of cases would be valuable in validating these results and strengthening their relevance to clinical practice,” they wrote.
Read the full study here.
