Background: Cone-beam breast CT (CBBCT) obtained FDA approval in the United States in 2015 for diagnostic use in conjunction with screening two-view mammography and for biopsy guidance. It utilizes 3D x-ray imaging to decrease tissue superimposition similar to digital breast tomosynthesis, however, breast compression is not necessary to acquire images. Contrast-enhanced CBBCT exploits tumor neovascularity and angiogenesis to elucidate malignant lesions much the same as contrast-enhanced breast MRI, but without the physical constraints of the magnet gantry and the contraindications of exposure to a magnetic field. CBBCT can also show microcalcifications not seen on MRI. In select cases, suspicious masses can be identified on CBBCT even without contrast.
Learning Objectives: After participating in this educational presentation, the learner will be able to:
• Describe the technique used in acquiring breast CT images • Compare and contrast the appearance of pathology on mammography, CBBCT and breast MRI • List potential scenarios where CBBCT could be used in replacement of breast MRI
Abstract Content/Results: Content
The focus of this exhibit is to highlight how CBBCT can be utilized in conjunction with other breast imaging modalities. We will provide a series of 10 cases where CBBCT demonstrates equal or better visualization of suspicious masses and mammographically-occult lesions when compared to breast MRI.
Figure 1: 47 year-old woman with palpable lump in the right upper inner breast, designated a BIRADS category 5 lesion by mammography and breast ultrasound. CBBCT and breast MRI show the palpable dominant enhancing mass at 2:00 and an additional mass and an additional area of nonmass enhancement in the same quadrant consistent with multifocal malignancy.
Conclusion: CBBCT is a useful tool for the evaluation of breast cancer patients, particularly for preoperative assessment of extent of disease. CBBCT has comparable diagnostic performance to breast MRI in patients with high suspicion of or known breast malignancy and should be considered as a substitute in patients that cannot undergo breast MRI.
