Cone beam breast CT with multiplanar and three dimensional visualization in differentiating breast masses compared with mammography.

Objective: This pilot study was to evaluate cone beam breast computed tomography (CBBCT) with multiplanar and three dimensional (3D) visualization in differentiating breast masses in comparison with two-view mammograms.

Methods: Sixty-five consecutive female patients (67 breasts) were scanned by CBBCT after conventional two-view mammography (Hologic, Motarget, compression factor 0.8). For CBBCT imaging, three hundred (1024 × 768 × 16b) two-dimensional (2D) projection images were acquired by rotating the x-ray tube and a flat panel detector (FPD) 360 degree around one breast. Three-dimensional CBBCT images were reconstructed from the 2D projections. Visage CS 3.0 and Amira 5.2.2 were used to visualize reconstructed CBBCT images.

Results: Eighty-five breast masses in this study were evaluated and categorized under the breast imaging reporting and data system (BI-RADS) according to plain CBBCT images and two-view mammograms, respectively, prior to biopsy. BI-RADS category of each breast was compared with biopsy histopathology. The results showed that CBBCT with multiplanar and 3D visualization would be helpful to identify the margin and characteristics of breast masses. The category variance ratios for CBBCT under the BI-RADS were 23.5% for malignant tumors (MTs) and 27.3% for benign lesions in comparison with pathology, which were evidently closer to the histopathology results than those of two-view mammograms, p value <0.01. With the receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) of CBBCT was 0.911, larger than that (AUC 0.827) of two-view mammograms, p value <0.01.

Conclusion: CBBCT will be a distinctive noninvasive technology in differentiating and categorizing breast masses under BI-RADS. CBBCT may be considerably more effective to identify breast masses, especially some small, uncertain or multifocal masses than conventional two-view mammography.