After breast traditionalist treatment, the rate of repetitive breast carcinoma is almost 1% per year. Early discovery of locally repetitive breast carcinoma has been appeared to altogether move forward long-term survival [8]. DCE-MRI has been appeared to be a profitable apparatus in discovery and characterization of recurrent breast carcinoma. MRI has been appeared to be valuable in separating postoperative scar from repetitive breast carcinoma. The capacity of MRI to distinguish between re-current breast carcinoma and generous post-treatment changes depends on its capacity to survey both injury morphology and contrast uptake [8].
However, magnetic resonance imaging shows many limitations. Thus, another modality was needed to overcome these limitations [4]. Subsequently, DBT can be added to the usual examination and provide better execution than classic DM especially in dense breast [9].
In our study, we evaluated 30 female patients who were surgically treated by conservative breast surgery. The mean patient age was 50.73 (range: 35–66). DBT with the US identified eight recurrent cases compared to the histopathology and 20 cases benign findings. MRI identified eight recurrent cases compared to the histopathology and 19 cases with benign findings (Fig. 4).
DBT and US had only one false-negative case proved to be recurrent mass (IDC) by histopathology and one false positive case proved to be fat necrosis by histopathology. MRI had one false-negative case proved to be recurrent mass (DCIS) by histopathology and two false- positive cases proved to be intracanalicular fibroadenoma, and sclerosing adenosis by histopathology.
The results of DBT, US, and MRI those were interpreted according to the ACR-BIRADS scoring system with ultrasound results were as the following: BIRADS II (53.3%), BIRADS III (16.7), BIRADS IV (20%) and BIRADSV (10%). MRI results were as the following: BIRADS II (53.4%), BIRADS III (Fig. 5). (13.3%), BIRADS IV (23.3%), and BIRADSV (10%).
DBT with the US had 20 true negative cases, eight true positive cases, one false positive case, and one false-negative case. MRI had 19 true negative cases, eight true positive cases, two false-positive cases, and one false-negative case. One case which was graded by DBT and US as BIRADS 3 lesion and by MRI as BIRADS 4 lesion proved to be recurrent mass (IDC) by histopathology, a result was consistent with MRI findings. One case which was graded by DBT and US as BIRADS 4 lesion and by MRI BIRADS 3 proved to be fat necrosis by histopathology, a result was consistent with MRI finding. One case which was graded by DBT and US as BIRADS 3 and by MRI as BIRADS 4 lesion proved to be fibroadenoma by histopathology. Another case which was graded by DBT and US as BIRADS 2 and by MRI as BIRADS 4 proved to be sclerosing adenosis by histopathology. One case which was graded by DBT and US as BIRADS 4 and by MRI as BIRADS 3 proved to be (DCIS) by histopathology, a result was consistent with DBT and US findings.
In our study, DBT with complementary US showed greater specificity (95.2%) than MRI (90.5%), yet it revealed the same sensitivity (88.9%). Subsequently, DBT with complementary ultrasound shows higher accuracy (93.3%) and higher PPV (88.9%) than MRI (90%), (80%) respectively. However, both of them revealed comparable NPV: DBT with the US: (95%) and MRI: (95%).
Early reports and studies of DBT were focused on its usual screening role. They have visualized its capability to diminish the number of recall rates and also to improve the cancer detection rates. To our knowledge, we are the first study that compares DBT with the complementary US to MRI in the assessment of postoperative changes and locoregional recurrence of breast cancer.
Rossano et al. [10] conducted a study on preoperative assessment of breast cancer patients that combined DBT with automated breast US and compared it to MRI. It revealed that DBT with the US had lower sensitivity than MRI. The concluded sensitivity for DBT, US, and MRI (76.5% vs 91.7%), respectively. The study showed statistically different results from our study. However, this may be related to several factors such as the use of automated breast ultrasound, larger number of patients, and the study was done on patients preoperatively. Christopher et al. [11] conducted a study that compared DBT to MRI, which revealed that MRI had higher sensitivity and lower specificity than DBT. The concluded results of sensitivity and specificity for MRI and DBT were (95.7% vs 39.1%) (86.7% vs 97.4%) respectively. However, the study used an abbreviated MRI technique and the study aimed to detect breast cancer among women with dense breasts. Another study done by Ola et al. showed a higher sensitivity specificity, and accuracy of MRI. Yet, in contrast to us, it was conducted to evaluate the role of MRI in the early detection of recurrent breast cancer. The concluded sensitivity, specificity, and accuracy of MRI were (100%, 94%, 96%), respectively.
El-Adalany and El-Metwally [8] conducted a study to evaluate the role of MRI in the detection of breast cancer. The concluded sensitivity, specificity, NPV, PPV and accuracy (97.7%, 90%, 95.5%, 90%, 94.5%). The breast MRI was performed on a 1.5 T MR imagining system like our study. The results were statistically different from our study. This may be related to several factors such as a larger number of patients, the use of unenhanced MRI techniques. Osman et al. [12] conducted a study to evaluate the role of DBT in treated breast cancer. The concluded sensitivity and specificity of DBT, PPV, NPV, and accuracy were lower than our study: (84.2%, 53.1%, 86.7%, 48.9%, 64%), respectively.
Mariscotti et al. [13] showed the same results in our study as regards the higher specificity of DBT with the US than MRI. The concluded specificity of DBT, US, and MRI was (88.2% vs 74.2%), respectively. A breast MRI was performed on 1.5 T on both studies. However, the study evaluated the patients preoperatively. In concordance to our results, Roganovic et al. [14] revealed that DBT had higher sensitivity and specificity than MRI (100% vs 93.1%) vs (75% vs 60.7%), respectively. However, we have to put into consideration that the study was performed on a 3.0 T MR imaging system and our study was conducted on a 1.5 T MRI machine. Kamal et al. [9] conducted a study that compared MRI to DBT in the assessment of breast lesions and showed that DBT had lower specificity than MRI (80.7% vs 89.7), respectively.
As regards, the PPV and NPV DBT and US showed higher PPV than MRI. These results matched the studies done by Mariscotti et al. [13] Jung et al. [2], and Roganovic et al. [14]. In contrast to our study, Kamal et al. [9] MRI had higher PPV and NPV than DBT (74. 1% vs 60.53%) (97.2% vs 96. 9%), respectively.
Breast MRI was conducted on a 1.5 T MR imaging system in our study Mariscotti et al., [13], Jung et al. [2]. El-Adalany and El-Metwally, [8], and Rossano et al. [10] conducted their studies like our study on 1.5 T MRI machines. Roganovic et.al [14] use a higher 3.0 T MRI imaging system, while Kamal et al. [9] used a lower MRI operating machine than our study (1 T MR imaging system).
Moodie et al. [15], and Lam et al. [16]. stated that the added role of DBT in the detection of cancer breast after treated breast cancer has not been adequately and broadly examined yet. Up till now, a very low number of studies has screened the role of DBT in surgically treated breast cancer and its role in the detection of locoregional recurrence, yet it has revealed a significant reduction in recall rates.