Diagnostic Efficacy across Dense and Non-Dense Breasts during Digital Breast Tomosynthesis and Ultrasound Assessment for Recalled Women

Abstract

Background: To compare the diagnostic efficacy of digital breast tomosynthesis (DBT) and ultrasound across breast densities in women recalled for assessment. Methods: A total of 482 women recalled for assessment from January 2017 to December 2019 were selected for the study. Women met the inclusion criteria if they had undergone DBT, ultrasound and had confirmed biopsy results. We calculated sensitivity, specificity, PPV, and AUC for DBT and ultrasound. Results: In dense breasts, DBT showed significantly higher sensitivity than ultrasound (98.2% vs. 80%; p < 0.001), but lower specificity (15.4% vs. 55%; p < 0.001), PPV (61.3% vs. 71%; p = 0.04) and AUC (0.568 vs. 0.671; p = 0.001). In non-dense breasts, DBT showed significantly higher sensitivity than ultrasound (99.2% vs. 84%; p < 0.001), but no differences in specificity (22% vs. 33%; p = 0.14), PPV (69.2% vs. 68.8%; p = 0.93) or AUC (0.606 vs. 0.583; p = 0.57). Around 73% (74% dense and 71% non-dense) and 77% (81% dense and 72% non-dense) of lesions assigned a RANZCR 3 by DBT and ultrasound, respectively, were benign. Conclusion: DBT has higher sensitivity, but lower specificity and PPV than ultrasound in women with dense breasts recalled for assessment. Most lesions rated RANZCR 3 on DBT and ultrasound are benign and may benefit from short interval follow-up rather than biopsy.

Digital breast tomosynthesis for breast cancer diagnosis in women with dense breasts and additional breast cancer risk factors: A systematic review

“…3 ). One study [ 20 ] reported a higher sensitivity of DBT (98.2 %, 95 % CI 94.8−99.6 %) than US (80.0 %, 95 % CI 73.0−85.6 %); another [ 23 ] reported a sensitivity of 100 % for both modalities. The specificity of DBT in recalled cohorts ranged from 15.4 % to 96.0 %, with US ranging from 55 % to 100 % ( Fig.…”

“…While one study did not find a difference between the specificities [ 13 ], two studies reported conflicting results—the specificity of DBT was lower than US in one study (15.4 %, 95 % C.I. 9.6–23.0 % versus 55 %, 95 % CI 44.8−63.0 %) [ 20 ], but higher than US in another (81.3 % 95 % CI 71.8−88.7 % versus 53.9 %, 95 % CI 43.1−64.4 %) [ 23 ]. One study included mixed cohorts (symptomatic and recalled patients); but did not report differences between sensitivity or specificity of DBT versus DM (86 % versus 97 % and 81 % versus 85 %, respectively) [ 11 ].…”

“…Fifteen studies reported positive predictive values (PPV), negative predictive values (NPV) or overall accuracy [ [11] , [12] , [13] , [14] , 18 , [20] , [21] , [22] , [23] , 27 , 28 , [30] , [31] , [32] , 35 ]. Studies comparing DBT with DM/SM consistently reported a higher PPV, NPV, and overall accuracy of DBT than DM; statistical significance was reported in only one study;however, the difference was not significant ( Supplementary Table 6 ).…”

“…Studies comparing DBT with DM/SM consistently reported a higher PPV, NPV, and overall accuracy of DBT than DM; statistical significance was reported in only one study;however, the difference was not significant ( Supplementary Table 6 ). Studies comparing DBT with US reported inconsistent results in predictive values, with three of the six studies reporting a lower PPV for DBT than for US [ 11 , 13 , 20 ], and three studies reporting a higher PPV for DBT [ 12 , 22 , 23 ].…”