Diagnostic Tomosynthesis Mammogram for Cone Compression Views
For cone compression views, you should order diagnostic digital breast tomosynthesis (DBT) instead of traditional diagnostic digital mammography with spot compression views. DBT has been demonstrated to provide equivalent or superior diagnostic accuracy compared to conventional cone compression mammography while potentially reducing radiation exposure 1, 2, 3.
Evidence Supporting DBT Over Traditional Cone Compression
Superior Diagnostic Performance
- DBT demonstrates significantly better diagnostic accuracy than standard mammography plus cone compression magnification views, with an area under the curve (AUC) of 0.93 compared to 0.87 for traditional approaches (p=0.0014) 4.
- Multiple studies confirm that DBT is at least equivalent to additional digital mammography views (magnification, spot compression, 90° views) while also reducing radiation exposure in both diagnostic and screening settings 1.
- The Italian College of Breast Radiologists and American College of Radiology both recommend that DBT can replace traditional spot compression views in most diagnostic situations 3.
Clinical Applications Where DBT Excels
- In symptomatic women, DBT improves diagnostic accuracy by reducing the number of suspicious findings and unnecessary biopsies 1.
- For palpable lesions, DBT has been reported to be never worse, and often better, than digital mammography for estimating tumor size 1.
- DBT is particularly effective for evaluating masses, asymmetric densities, noncalcified lesions, and screen-detected abnormalities requiring workup 3, 5.
How to Order
Recommended Ordering Language
- Order "Diagnostic mammography with digital breast tomosynthesis" rather than "diagnostic mammography with cone compression views" 3.
- The ACR recommends DBT as a modern alternative to traditional spot compression views with equivalent or superior diagnostic accuracy 1, 2.
Radiation Considerations
- Using synthesized 2D images reconstructed from DBT datasets instead of acquiring both standard 2D and DBT images reduces radiation exposure while maintaining diagnostic performance 1, 3.
- DBT can be used with or without spot compression views in the diagnostic context, and one-view breast tomosynthesis has been demonstrated to be equivalent to or better than supplemental diagnostic mammographic views 1, 3.
Critical Pitfalls to Avoid
Common Ordering Errors
- Do not order "screening mammography" for an abnormal finding—this requires diagnostic evaluation with additional views or DBT 2.
- Do not rely on ultrasound alone without mammographic evaluation, as mammography detects microcalcifications and architectural distortion that ultrasound may miss 2.
Concurrent Imaging Requirements
- Always order targeted ultrasound concurrently with diagnostic mammography/DBT to identify potentially benign causes and provide a target for biopsy if indicated 1, 2, 3.
- Ultrasound helps distinguish between fluid and solid tissue, which mammography alone cannot reliably differentiate 2.
When Traditional Cone Compression May Still Be Needed
Specific Scenarios
- Magnification views remain particularly helpful when evaluating associated microcalcifications 1, 2, 3.
- DBT can be used with or without spot compression views depending on the clinical scenario 1, 3.