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To compare the accuracy of breast lesion size measurement of cone-beam breast-CT (CBBCT), digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM).Patients scheduled for mastectomy due to at least 1 malignant breast lesion were included. Mastectomy specimens were examined by CBBCT, DBT, FFDM, and histopathology.A total of 94 lesions (40 patients) were included. Histopathological analyses revealed 47 malignant, 6 high-risk, and 41 benign lesions. Mean histopathological lesion size was 20.8 mm (range 2-100). Mean absolute size deviation from histopathology was largest for FFDM (5.3 ± 6.7 mm) and smallest for CBBCT 50 mA, high-resolution mode (4.3 ± 6.7 mm). Differences between imaging modalities did not reach statistical significance (P = .85).All imaging methods tend to overestimate breast lesion size compared to histopathological gold standard. No significant differences were found regarding size measurements, although in tendency CBBCT showed better lesion detection and cT classification over FFDM.

Objectives: To evaluate whether post-contrast cone-beam breast CT (CBBCT) alone is comparable to the current standard of combined pre- and post-contrast CBBCT regarding diagnostic accuracy and superior regarding radiation exposure., Material and Methods: This study included 49 women (61 breasts) with median age 57.9 years and BI-RADS 4/5 lesions diagnosed on mammography/ultrasound in density type c/d breasts. Two radiologists rated post-contrast CBBCT and pre- and post-contrast CBBCT with subtraction images on the BI-RADS scale separately for calculation of inter- and intra-observer agreement and in consensus for diagnostic accuracy assessment. Sensitivity, specificity, and area under the curve (AUC) were compared via McNemar test and DeLong method, respectively. Subtraction imaging misregistration were measured from 1 (no artifacts) to 4 (artifacts with width > 4 mm)., Results: A total of 100 lesion (51 malignant; 6 high risk; 43 benign) were included. AUC, sensitivity, and specificity showed no significant differences comparing post-contrast CBBCT alone versus pre- and post-contrast CBBCT (AUC 0.84 vs. 0.83, p = 0.643; sensitivity 0.89 vs. 0.85, p = 0.158; specificity 0.73 vs. 0.76, p = 0.655). Inter- and intra-observer agreement was excellent (intra-class correlation coefficient ICC = 0.76, ICC = 0.83, respectively). Radiation dose was significantly lower for post-contrast CBBCT alone versus pre- and post-contrast CBBCT (median average glandular radiation dose 5.9 mGy vs. 11.7 mGy, p < 0.001). High-degree misregistrations were evident in the majority of subtraction images (level 1/2/3/4 16.9%/27.1%/16.9%/39%), in particular for bilateral exams (3.2%/29.2%/8.3%/58.3%)., Conclusion: Diagnostic accuracy of post-contrast CBBCT alone is comparable to pre- and post-contrast CBBCT in type c/d breasts, while yielding a significant twofold radiation dose reduction., Key Points: • The diagnostic accuracy of post-contrast CBBCT alone is comparable to dual acquisition of pre- and post-contrast CBBCT. • Acquisition of the post-contrast CBBCT scan alone reduces radiation exposure compared to pre- and post-contrast CBBCT, thus countering one of the main limitations of CBBCT. • High-degree misregistration artifacts limit the interpretation of subtraction images from pre- and post-contrast CBBCT studies.

Objectives: To evaluate the diagnostic accuracy of contrast-enhanced (CE) cone-beam breast computed tomography (CBBCT) in dense breast tissue and compare it to non-contrast (NC) CBBCT, mammography (MG) and magnetic resonance imaging (MRI)., Methods: This prospective institutional review board-approved study included 41 women (52 breasts) with American College of Radiology (ACR) density types c or d and Breast Imaging Reporting and Data System (BI-RADS) 4 or 5 assessments in MG or ultrasound (US). Imaging modalities were independently evaluated by two blinded readers., Results: A total of 100 lesions (51 malignant, 6 high-risk, and 43 benign) were identified. For readers 1/2, respectively, and p values comparing CE-CBBCT to other modalities: diagnostic accuracy (AUC) for CE-CBBCT was 0.83/0.77, for MRI 0.88/0.89 (p = 0.2272/0.002), for NC-CBBCT 0.73/0.66 (p = 0.038/ 0.0186) and for MG 0.69/0.64 (p = 0.081/0.0207). CE-CBBCT sensitivity (0.88/0.78) was 37-39% higher in comparison to MG (0.49/0.41, p < 0.001 both) but inferior to MRI (0.98/0.96, p = 0.0253/0.0027). CE-CBBCT specificity (0.71/0.71) was numerically higher compared to MRI (0.61/0.69, p = 0.0956/0.7389)., Conclusions: CBBCT diagnostic performance varied with the respective reader and experience. CE-CBBCT improved AUC and sensitivity in comparison to MG and NC-CBBCT, and was comparable to MRI in dense breast tissue. In tendency, specificity was higher for CE-CBBCT than MRI., Key Points: • CE-CBBCT diagnostic accuracy (AUC) was comparable to MRI in dense breasts. • CE-CBBCT improved sensitivity and AUC in comparison to MG and NC-CBBCT. • CE-CBBCT has inferior sensitivity but higher specificity than MRI. • CE-CBBCT is a potential imaging alternative for patients with MRI contraindications.

Objectives: To evaluate the impact of breast density on the diagnostic accuracy of non-contrast cone-beam breast computed tomography (CBBCT) in comparison to mammography for the detection of breast masses., Methods: A retrospective study was conducted from August 2015 to July 2016. Fifty-nine patients (65 breasts, 112 lesions) with BI-RADS, 5th edition 4 or 5 assessment in mammography and/or ultrasound of the breast received an additional non-contrast CBBCT. Independent double blind reading by two radiologists was performed for mammography and CBBCT imaging. Sensitivity, specificity and AUC were compared between the modalities., Results: Breast lesions were histologically examined in 85 of 112 lesions (76%). The overall sensitivity for CBBCT (reader 1: 91%, reader 2: 88%) was higher than in mammography (both: 68%, p<0.001), and also for the high-density group (p<0.05). The specificity and AUC was higher for mammography in comparison to CBBCT (p<0.05 and p<0.001). The interobserver agreement (ICC) between the readers was 90% (95% CI: 86-93%) for mammography and 87% (95% CI: 82-91%) for CBBCT., Conclusions: Compared with two-view mammography, non-contrast CBBCT has higher sensitivity, lower specificity, and lower AUC for breast mass detection in both high and low density breasts., Key Points: • Overall sensitivity for non-contrast CBBCT ranged between 88%-91%. • Sensitivity was higher for CBBCT than mammography in both density types (p<0.001). • Specificity was higher for mammography than CBBCT in both density types (p<0.05). • AUC was larger for mammography than CBBCT in both density types (p<0.001).

Objective: To investigate the optimal acquisition time of contrast-enhanced cone-beam breast-CT (CBBCT) for best discrimination of breast lesion malignancy and whether contrast enhancement can aid in classification of tumor histology.Material and Methods: The study included patients with BI-RADS 4 or 5 lesions identified on mammography and/or ultrasound. All patients were examined by non-contrast (NC-CBBCT) and contrast-enhanced CBBCT (CE-CBBCT) at 2 and 3min after contrast media (CM) injection. Lesion enhancement of suspicious breast lesions was evaluated in corresponding CBBCT slices.Results: A total of 31 patients with 57 breast lesions, 30 malignant and 27 benign, were included. Malignant breast lesions demonstrated higher contrast enhancement than benign breast lesions at both 2min and 3min CE-CBBCT (2min: 48.17 vs. 0.3 HU, p<0.001; 3min: 57.38 vs. 15.43 HU, p<0.001). Enhancement differences between malignant and benign breast lesions were largest at 2min CE-CBBCT. Ductal carcinoma in situ (DCIS) showed highest mean contrast enhancement among malignant breast lesions (100.93 HU at 3min CE-CBBCT, p=0.0314) compared to invasive carcinoma of no special type with DCIS component (55.82 HU at 3min CE-CBBCT) and invasive ductal carcinoma (52.31 HU at 3min CE-CBBCT).Conclusions: The contrast enhancement on CE-CBBCT best discriminates between malignant and benign breast lesions at 2min after CM injection. The enhancement has the potential to differentiate histopathological subtypes, with highest enhancement among malignant lesions seen for DCIS. [ABSTRACT FROM AUTHOR]