Improved visualization of spiculated masses with digital breast tomosynthesis: how does size measurement correlate with pathology?

Objectives: To assess the accuracy of size measurements of spiculated masses for both 2D mammography (MX) and Digital Breast Tomosynthesis (DBT) in comparison to histopathologic outcomes in breast cancer patients. Methods: A retrospective study was conducted from January 2015 till December 2016 with inclusion of biopsy proven breast cancer patients who presented themselves with masses with spicules. Two readers performed size measurements of both the masses only as well as of the masses with spicules. Results were compared to histopathological results. Results: A total of 180 spiculated masses were included in this study. Analysis showed that for the mass only measurements both readers showed a significant underestimation on both 2D Mx as well as DBT versus histopathology. While the mass with spicules measurements showed more variable results, partly depending on tumor size and clinical working experience. We found no influence of viewing direction or breast density. Conclusions: Even with DBT it is very difficult to determine the correct size of spiculated mases. Measurements of only the central mass are not correlating well with histopathology. Especially for larger masses (> 25mm), radiologists tend to underestimate the size of spiculated masses. For smaller masses measurement of the mass center only as well as inclusion of the spicules correlated well with pathology sizes.