Dedicated Three-dimensional Breast Computed Tomography: Lesion Characteristic Perception by Radiologists.

OBJECTIVES: To assess radiologist confidence in the characterization of suspicious breast lesions with a dedicated three-dimensional breast computed tomography (DBCT) system in comparison to diagnostic two-dimensional digital mammography (dxDM). MATERIALS AND METHODS: Twenty women were recruited who were to undergo a breast biopsy for a Breast Imaging-Reporting and Data System (BI-RADS) 4 or 5 lesion evaluated with dxDM in this Institutional Review Board-approved study. The enrolled subjects underwent imaging of the breast(s) of concern using DBCT. Seven radiologists reviewed the cases. Each reader compared DBCT to the dxDM and was asked to specify the lesion type and BI-RADS score for each lesion and modality. They also compared lesion characteristics: Shape for masses or morphology for calcifications; and margins for masses or distribution for calcifications between the modalities using confidence scores (0-100). RESULTS: Twenty-four biopsied lesions were included in this study: 17 (70.8%) masses and 7 (29.2%) calcifications. Eight (33.3%) lesions were malignant, and 16 (66.7%) were benign. Across all lesions, there was no significant difference in the margin/distribution (Δ = -0.99, P = 0.84) and shape/morphology (Δ = -0.10, P = 0.98) visualization confidence scores of DBCT in relation to dxDM. However, analysis by lesion type showed a statistically significant increase in reader shape (Δ =11.34, P = 0.013) and margin (Δ =9.93, P = 0.023) visualization confidence with DBCT versus dxDM for masses and significant decrease in reader morphology (Δ = -29.95, P = 0.001) and distribution (Δ = -28.62, P = 0.002) visualization confidence for calcifications. CONCLUSION: Reader confidence in the characterization of suspicious masses is significantly improved with DBCT, but reduced for calcifications. Further study is needed to determine whether this technology can be used for breast cancer screening.

Whole Breast Ultrasound: Comparison of the Visibility of Suspicious Lesions with Automated Breast Volumetric Scanning Versus Hand-Held Breast Ultrasound.

RATIONALE AND OBJECTIVES: To assess how well radiologists visualize relevant features of lesions seen with automated breast volumetric scanning (ABVS) in comparison to hand-held breast ultrasound in women going to breast biopsy. MATERIALS AND METHODS: Twenty-five subjects were recruited from women who were scheduled to undergo a breast biopsy for at least one Breast Imaging-Reporting and Data System four or five lesion identified in a diagnostic setting. In this institutional review board-approved study, the subjects underwent imaging of the breast(s) of concern using a dedicated system that allowed both hand-held breast ultrasound and ABVS. Five experienced breast radiologists reviewed the 30 lesions in 25 subjects in a reader study. Each reader was asked to specify the lesion type, size, imaging features, Breast Imaging-Reporting and Data System, and suspicion of malignancy and to compare the lesion characteristics of shape and margins between the two modalities. RESULTS: Seven (23.3%) masses were malignant and 23 (76.4%) were benign. Across all lesions regardless of size or final pathology, there was no significant difference in sensitivity or specificity (P > .15) between the two modalities. For malignant lesions, the reader visualization confidence scores between the two ultrasound modalities were not significantly different (P > .1). However, analysis for nonmalignant cases showed a statistically significant increase in reader visualization confidence in lesion shape and margins (P < .001). CONCLUSIONS: Radiologists showed increased confidence in visualization of benign masses and equal confidence in suspicious masses with ABVS imaging. This information could help decrease the need for additional hand-held imaging after automated whole breast ultrasound.

Dedicated 3D photoacoustic breast imaging.

PURPOSE: To report the design and imaging methodology of a photoacoustic scanner dedicated to imaging hemoglobin distribution throughout a human breast. METHODS: The authors developed a dedicated breast photoacoustic mammography (PAM) system using a spherical detector aperture based on our previous photoacoustic tomography scanner. The system uses 512 detectors with rectilinear scanning. The scan shape is a spiral pattern whose radius varies from 24 to 96 mm, thereby allowing a field of view that accommodates a wide range of breast sizes. The authors measured the contrast-to-noise ratio (CNR) using a target comprised of 1-mm dots printed on clear plastic. Each dot absorption coefficient was approximately the same as a 1-mm thickness of whole blood at 756 nm, the output wavelength of the Alexandrite laser used by this imaging system. The target was immersed in varying depths of an 8% solution of stock Liposyn II-20%, which mimics the attenuation of breast tissue (1.1 cm(-1)). The spatial resolution was measured using a 6 µm-diameter carbon fiber embedded in agar. The breasts of four healthy female volunteers, spanning a range of breast size from a brassiere C cup to a DD cup, were imaged using a 96-mm spiral protocol. RESULTS: The CNR target was clearly visualized to a depth of 53 mm. Spatial resolution, which was estimated from the full width at half-maximum of a profile across the PAM image of a carbon fiber, was 0.42 mm. In the four human volunteers, the vasculature was well visualized throughout the breast tissue, including to the chest wall. CONCLUSIONS: CNR, lateral field-of-view and penetration depth of our dedicated PAM scanning system is sufficient to image breasts as large as 1335 mL, which should accommodate up to 90% of the women in the United States.