Comparison of Full-Field Digital Mammography and Screen-Film Mammography for Detection and Characterization of Simulated Small Masses

Abstract

OBJECTIVE-The two objectives of this study were to create an ex vivo phantom model that closely mimics human breast cancer for detection tasks and to compare the performance of full-field digital mammography with screen-film mammography in detecting and characterizing small breast masses in a phantom with a spectrum of complex tissue backgrounds.MATERIALS AND METHODS-Sixteen phantom breast masses of varying sizes (0.3-1.2 cm), shapes (round and irregular), and densities (high and low) were created from shaved tumor specimens and imaged using both full-field digital and screen-film mammography techniques. We created 408 detection tasks that were captured on 68 films. On each radiograph, six detection tasks were partially obscured by areas of varying breast-pattern complexity, including low (predominantly fatty), mixed (scattered fibroglandular densities and heterogeneously dense), and high (extremely dense) density patterns. Each detection task was scored using a five-point confidence scale by three mammographers. Receiver operating characteristic (ROC) curve analysis was performed to analyze differences in detection of masses between the two imaging systems, and sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were computed.RESULTS-Full-field digital mammography showed higher area under the ROC curve than screenfilm mammography for detecting masses in each breast background and performed significantly better than screen-film mammography in mixed (p = 0.010), dense (p = 0.029), and all breast backgrounds combined (p = 0.004). Full-field digital mammography was superior to screen-film mammography for characterizing round and irregular masses and low-and high-density masses.CONCLUSION-Full-field digital mammography was significantly superior to screen-film technique for detecting and characterizing small masses in mixed and dense breast backgrounds in a phantom model. Keywords breast neoplasms; breast radiography; digital radiography; phantoms Results of both randomized controlled clinical trials and meta-analyses have shown that screenfilm mammographic screening in women 40 years old and older may reduce the breast cancer mortality rate by up to 45% [1][2][3]. This decrease in the mortality rate has been attributed to the ability of screen-film mammography to identify cancers early when they appear as small, nonpalpable masses, calcifications, or both. The effectiveness of screen-film mammography is limited by its narrow dynamic range, low contrast resolution, image noise, and film

Differences in radiological patterns, tumour characteristics and diagnostic precision between digital mammography and screen-film mammography in four breast cancer screening programmes in Spain

“…Therefore, whereas there are no conclusive data indicating better diagnostic precision in DM for some mammographic findings (calcifications, distortions and asymmetries), DM is clearly more precise in detecting masses. This result is also consistent with the findings of a phantom study by Yang et al, who found that DM was significantly superior to SFM in detecting and characterizing small masses in mixed and dense breast backgrounds [27]. In a recent study, Pinker et al reported that DM was significantly superior to SFM in the conspicuity of screen-detected breast cancers for all histological types and breast densities regardless of manifestation as mass; in addition, architectural distortion, asymmetric density or microcalcifications were also better visualized by DM [28].…”

Diagnostic performance of detecting breast cancer on computed radiographic (CR) mammograms: comparison of hard copy film, 3-megapixel liquid-crystal-display (LCD) monitor and 5-megapixel LCD monitor

“…Numerous studies have evaluated the performance of full-field digital mammography (FFDM) [3][4][5][6][7][8][9][10][11][12][13][14]. As these studies focused on the ability of digital mammography to detect breast cancer, soft-copy reading may not have been evaluated fully.…”

“…Many studies have compared the diagnostic performance of digital mammography and screen-film mammography [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. For instance, the Digital Mammographic Imaging Screening Trial (DMIST) recently showed that the digital mammography technique using a flat panel detector and computed radiography (CR) system was superior for detecting breast cancer in women of less than 50 years of age, those with dense breasts, and premenopausal women [7].…”

Breast Cancer: Missed Interval and Screening-detected Cancer at Full-Field Digital Mammography and Screen-Film Mammography— Results from a Retrospective Review

“…There was a trend toward a lower percentage of masses with spiculated margins and a trend toward a higher percentage of masses with indistinct margins at FFDM than at SFM. These findings can be explained by higher contrast resolution at FFDM than at SFM, which makes it easier to distinguish a mass from the surrounding glandular tissue (13). The ability to optimize FFDM images by using postprocessing procedures might further influence the perception and categorization of a small mass.…”