Comparative study of Diagnostic Accuracy of Ultrasonography vs. Digital Mamography vs. Digital Breast Tomosynthesis vs. Breast MRI in Screening of Women with Dense Breasts

Background: The aim of this study was to assess the diagnostic accuracy for digital mammography, digital breast tomosynthesis, ultrasonography and breast MRI, as a screening methods in dense breasts, applied individually and in combination in detection of an early cancer. Methods: The retrospective study was conducted from January 2021 to september 2024 at the Oncology Institute of Vojvodina in Serbia, which included 168 women with dense breasts who were referred for an examination because of regular control or objective findings in breasts, and who underwent all 4 diagnostics imaging: digital mammography (DM), digital breast tomosynthesis (DBT), ultrasonography (US) and breast MRI. According to the 5th edition of ACR BIRADS atlas, suspicious malignancy was categorized as BIRADS 4 and 5, and benign findings as BIRADS 1, 2 and 3. The reference standard for checking the diagnostic accuracy of these methods was the result of histopathology, if the biopsy is done, or stable radiological finding in the next 12-24 months. Results: The examined women were aged from 28 to 77 years. Histopathology analysis revealed malignancy in 89 women, while 67 had a benign finding (19 was biopsy verified). DM has the lowest sensitivity (87.7%) and specificity (49.3%) in an early cancer detection. Adding of DBT to DM, sensitivity increased to 88.9%, and specificity to 56%. US has a high sensitivity of 90.1%, but a very low specificity of 48%. Breast MRI has the highest sensitivity 95.1%, and specificity 78.7%. Combination of DM+DBT and US yield increased the sensitivity, but decrease the specificity because of high rate of false positive findings. The highest PPV and NPV had breast MRI, 82.8% and 93.7% respectively, and the lowest digital mammography, 65.1% and 78.7% respectively. Adding of breast MRI to DM+DBT+US didnot significant change results in a sensitivity of 97.5%, but it has decreased specificity to 29.3%. Conclusions: US in combination with DM and DBT, can significantly improve the diagnostic accuracy in screening of dense breasts, similar as breast MRI, in regions where there are no magnetic resonance units. Limiting factors are low specificity and high PPV.