Masses in the era of screening tomosynthesis: Is diagnostic ultrasound sufficient?

objectives: The purpose of this study is to compare diagnostic outcomes of digital breast tomosynthesis screen-detected masses worked up with mammography first with those evaluated with diagnostic ultrasound initially. Methods: All masses recalled from screening digital breast tomosynthesis between July 1, 2017 and December 31, 2017 that were sent either to diagnostic mammography or ultrasound were compared. Size, shape, margins, visibility on ultrasound, diagnostic assessment and pathology of all masses along with breast density were evaluated. results: 102/212 digital breast tomosynthesis screen-detected masses were worked up with diagnostic mammography initially and 110/212 were worked up with ultrasound directly. There was no significant difference in ultrasound visibility of masses sent to diagnostic mammography first with those sent to ultrasound first (p = 0.42). 4 (4%) masses sent to mammogram first and 2 (2%) masses sent to ultrasound first were not visualized. There was a significant difference in size between masses that were visualized under ultrasound versus those that were not (p = 0.01), when masses in both groups were assessed cumulatively. Conclusions: 98% of digital breast tomosynthesis screen-detected masses sent to ultrasound directly were adequately assessed without diagnostic mammography. advances in knowledge: There is potential for avoiding a diagnostic mammogram for evaluation of majority of digital breast tomosynthesis screen-detected masses.