Digital breast tomosynthesis (DBT) addresses some of the limitations encountered with standard mammographic views. In addition to planar images, DBT creates thin-section reconstructed images, which decreases the lesion- masking effect of overlapping normal tissue. In the screening setting, some authors found the advantages of DBT to be especially pronounced in patients <50 years of age [17,18], in patients with dense breasts [17,19], and with lesion types including spiculated masses, [20] asymmetries [21], and architectural distortion [22]. DBT is also useful in the diagnostic setting, improving lesion characterization [22-25] in noncalcified lesions compared with conventional mammography. A prospective study of 166 patients with breast cancer compared digital mammography (DM) to combined DM plus DBT for accuracy of local tumor staging. They demonstrated better accuracy of DM plus DBT for detecting additional ipsilateral and contralateral disease in patients with nondense breasts [26]. A retrospective study of 222 cancers demonstrated that pathologic response to NAC was less likely with the baseline mammographic finding of spiculation [27]. Because of the presence of dense tissue in up to 50% of patients, obscured margins may limit evaluation of the extent of disease [28]. Therefore, mammography or DBT is most often combined with other modalities, such as US or MRI, to guide clinical management. FDG-PET/CT Skull Base to Mid-Thigh Fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT has a low sensitivity for detection of primary breast cancer because of the low spatial resolution of the scanners and the relatively low FDG uptake of both invasive lobular cancers and low-grade malignancies [29,30]. As a result, this modality is not routinely used for pretreatment imaging of the primary breast tumor.
Monitoring Response to Neoadjuvant Systemic Therapy for Breast Cancer. Digital breast tomosynthesis (DBT) addresses some of the limitations encountered with standard mammographic views. In addition to planar images, DBT creates thin-section reconstructed images, which decreases the lesion- masking effect of overlapping normal tissue. In the screening setting, some authors found the advantages of DBT to be especially pronounced in patients <50 years of age [17,18], in patients with dense breasts [17,19], and with lesion types including spiculated masses, [20] asymmetries [21], and architectural distortion [22]. DBT is also useful in the diagnostic setting, improving lesion characterization [22-25] in noncalcified lesions compared with conventional mammography. A prospective study of 166 patients with breast cancer compared digital mammography (DM) to combined DM plus DBT for accuracy of local tumor staging. They demonstrated better accuracy of DM plus DBT for detecting additional ipsilateral and contralateral disease in patients with nondense breasts [26]. A retrospective study of 222 cancers demonstrated that pathologic response to NAC was less likely with the baseline mammographic finding of spiculation [27]. Because of the presence of dense tissue in up to 50% of patients, obscured margins may limit evaluation of the extent of disease [28]. Therefore, mammography or DBT is most often combined with other modalities, such as US or MRI, to guide clinical management. FDG-PET/CT Skull Base to Mid-Thigh Fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT has a low sensitivity for detection of primary breast cancer because of the low spatial resolution of the scanners and the relatively low FDG uptake of both invasive lobular cancers and low-grade malignancies [29,30]. As a result, this modality is not routinely used for pretreatment imaging of the primary breast tumor.