Digital Breast Tomosynthesis versus Supplemental Diagnostic Mammographic Views for Evaluation of Noncalcified Breast Lesions

Abstract

Purpose:To compare the diagnostic performance of breast tomosynthesis versus supplemental mammography views in classification of masses, distortions, and asymmetries. Materials and Methods:Eight radiologists who specialized in breast imaging retrospectively reviewed 217 consecutively accrued lesions by using protocols that were HIPAA compliant and institutional review board approved in 182 patients aged 31-60 years (mean, 50 years) who underwent diagnostic mammography and tomosynthesis. The lesions in the cohort included 33% (72 of 217) cancers and 67% (145 of 217) benign lesions. Eighty-four percent (182 of 217) of the lesions were masses, 11% (25 of 217) were asymmetries, and 5% (10 of 217) were distortions that were initially detected at clinical examination in 8% (17 of 217), at mammography in 80% (173 of 217), at ultrasonography (US) in 11% (25 of 217), or at magnetic resonance imaging in 1% (2 of 217). Histopathologic examination established truth in 191 lesions, US revealed a cyst in 12 lesions, and 14 lesions had a normal follow-up. Each lesion was interpreted once with tomosynthesis and once with supplemental mammographic views; both modes included the mediolateral oblique and craniocaudal views in a fully crossed and balanced design by using a five-category Breast Imaging Reporting and Data System (BI-RADS) assessment and a probability-of-malignancy score. Differences between modes were analyzed with a generalized linear mixed model for BI-RADS-based sensitivity and specificity and with modified Obuchowski-Rockette approach for probability-of-malignancy-based area under the receiver operating characteristic (ROC) curve. Results:Average probability-of-malignancy-based area under the ROC curve was 0.87 for tomosynthesis versus 0.83 for supplemental views (P , .001). With tomosynthesis, the false-positive rate decreased from 85% (989 of 1160) to 74% (864 of 1160) (P , .01) for cases that were rated BI-RADS category 3 or higher and from 57% (663 of 1160) to 48% (559 of 1160) for cases rated BI-RADS category 4 or 5 (P , .01), without a meaningful change in sensitivity.With tomosynthesis, more cancers were classified as BI-RADS category 5 (39% [226 of 576] vs 33% [188 of 576]; P = .017) without a decrease in specificity. Conclusion:Tomosynthesis significantly improved diagnostic accuracy for noncalcified lesions compared with supplemental mammographic views.

Role of Breast Tomosynthesis in Diagnosis of Breast Cancer for Japanese Women

“…Similar results have been reported in previous studies on Western populations (Andersson et al, 2008;Hakim et al, 2010;Helvie, 2010;Teertstra et al, 2010;Williams et al, 2010;Vecchio et al, 2011;Michell et al, 2012;Alakhras et al, 2013;Houssami et al, 2013;Skaane et al, 2013;Zuley et al, 2013). Our study showed that 3DBT improved the diagnosis accuracy compared to 2DMMG in Japanese female population and 3DBT is a novel technique that may provide a breakthrough in solving the difficulties of diagnosis caused by parenchyma overlap in 2DMMG.…”

“…This technique allows the generation of 3D data and resolves the problem of tissue overlap. It was reported that the advantage of this technique is to improve the diagnostic accuracy by better visibility of the low contrast features that are hard to depict in conventional 2DMMG due to breast tissue overlap for Western women (Gur, 2007;Park et al, 2007;Michell et al, 2012;Alakhras et al, 2013;Houssami et al, 2013;Skaane et al, 2013;Zuley et al, 2013).…”

The TOMMY trial: a comparison of TOMosynthesis with digital MammographY in the UK NHS Breast Screening Programme – a multicentre retrospective reading study comparing the diagnostic performance of digital breast tomosynthesis and digital mammography with digital mammography alone

“…The reader study highlighted various aspects of reader performance that require further research in terms of inter-reader and intersite variations in operating point. The impact of longer reading times with DBT 16,19,40,46,68 needs to be considered if DBT is to be incorporated into the workflow of the screening programme. Chapter 7 Conclusions and future research A lthough our study was in agreement with recent published studies in demonstrating that 2D + DBT performed better than 2D alone in terms of specificity, we were unable to demonstrate the same significant increase in sensitivity for 2D + DBT reported in these studies in our retrospective reading study.…”

“…Although this study was not designed to assess DBT in the diagnostic and assessment setting, improved visualisation of benign and malignant features using DBT could reduce the need for additional ultrasound, MRI or supplemental mammographic imaging. [39][40][41][42] The screening population would also benefit if some of the anxiety and stress associated with breast screening from unnecessary recalls and additional testing could be reduced.…”

“…[28][29][30] Improved lesion visibility, size and classification compared with standard film or digital mammography have been reported [31][32][33][34][35][36][37][38] and the possibility that DBT could reduce the need for additional mammographic views at least for non-calcified lesions [39][40][41][42] has been suggested. There are mixed reports of the sensitivity of DBT for the detection of microcalcifications 32,[43][44][45][46][47][48][49][50][51] that may be partly as a result of the different techniques used for image reconstruction and the need to combine image slices into thicker slabs for optimal visualisation of microcalcification clusters.…”