Addition of Digital Breast Tomosynthesis to Full-Field Digital Mammography in the Diagnostic Setting: Additional Value and Cancer Detectability / 한국유방암학회지

PURPOSE: The purpose of this study was to assess the value of adding digital breast tomosynthesis (DBT) to full-field digital mammography (FFDM) in the diagnostic workup of breast cancer and to determine which lesion variables affect cancer detectability in the combined modality. METHODS: Between March and May 2012, paired FFDM and DBT images were obtained from 203 women as part of a diagnostic workup for breast cancer. Images from FFDM alone, DBT alone, and DBT combined with FFDM were reviewed in separate sessions by six blinded readers. Jackknife alternative free-response receiver operating characteristic (JAFROC) figure of merit (FOM), sensitivity, and specificity were compared between the modalities. Lesion characteristics affecting the cancer detection rate when using the combined modality were also analyzed. RESULTS: Among the 203 women, 126 women had a total of 129 malignancies and 77 women had total of 77 benign lesions. The overall JAFROC FOM of the combined modality was higher than that of FFDM alone (0.827 vs. 0.775, p<0.001) and that of DBT alone was higher than that of FFDM alone (0.807 vs. 0.775, p=0.027). The overall sensitivity of the combined modality was higher than that of FFDM alone (80.0% vs. 73.2%, p<0.001) and that of DBT alone was higher than that of FFDM alone (78.3% vs. 73.2%, p=0.007). Compared to FFDM alone, the combined modality detected an additional 48 cancers. Using the combined modality, the presence of masses or microcalcifications was significantly associated with the cancer detection rate (p<0.001). CONCLUSION: The combination of DBT with FFDM results in a higher diagnostic yield than FFDM alone. Additionally, DBT alone performs better than FFDM alone. However, even when DBT is combined with FFDM, breast cancers with no discernible masses and those lacking calcifications are difficult to detect.

A Case of Paranasal Diffuse Large B-Cell Lymphoma with the Orbital Invasion Masquerading as Chronic Sinusitis

PURPOSE: To report a case of paranasal diffuse large B-cell lymphoma with orbital invasion extending to the intracranial lesion. CASE SUMMARY: A 48-year-old male with chronic sinusitis visited our clinic for recent proptosis of his right eye, intermittent pain around the eyeball and headache. On a magnetic resonance image (MRI), a mass-like lesion was observed in the right frontal sinus, and its infiltration into the superior inner portion of the right orbital extraconal space and right intracranial dural space was suggestive of generalized inflammatory mucosal thickening in the paranasal sinuses. An incisional biopsy of the sinonasal tract was immediately performed. The pathology confirmed diffuse large B-cell lymphoma. CONCLUSIONS: A mass involving the paranasal sinus and orbit can masquerade as chronic sinusitis. Because diffuse large B-cell lymphoma is rare and is a high-grade aggressive malignant lymphoma, the possibility for diagnosis must be considered.