Does Reader Performance with Digital Breast Tomosynthesis Vary according to Experience with Two-dimensional Mammography?

Abstract

Purpose To assess whether individual reader performance with digital breast tomosynthesis (DBT) and two-dimensional (2D) mammography varies with number of years of experience or volume of 2D mammograms read. Materials and Methods After written informed consent was obtained, 8869 women (age range, 29-85 years; mean age, 56 years) were recruited into the TOMMY trial (A Comparison of Tomosynthesis with Digital Mammography in the UK National Health Service Breast Screening Program), an ethically approved, multicenter, multireader, retrospective reading study, between July 2011 and March 2013. Each case was read prospectively for clinical assessment and to establish ground truth. A retrospective reading data set of 7060 cases was created and randomly allocated for independent blinded review of (a) 2D mammograms, (b) DBT images and 2D mammograms, and (c) synthetic 2D mammograms and DBT images, without access to previous examinations. Readers (19 radiologists, three advanced practitioner radiographers, and two breast clinicians) who had 3-25 (median, 10) years of experience in the U.K. National Health Service Breast Screening Program and read 5000-13 000 (median, 8000) cases per annum were included in this study. Specificity was analyzed according to reader type and years and volume of experience, and then both specificity and sensitivity were analyzed by matched inference. The median duration of experience (10 years) was used as the cutoff point for comparison of reader performance. Results Specificity improved with the addition of DBT for all readers. This was significant for all staff groups (56% vs 68% and 49% vs 67% [P < .0001] for radiologists and advanced practitioner radiographers, respectively; 46% vs 55% [P = .02] for breast clinicians). Sensitivity was improved for 19 of 24 (79%) readers and was significantly higher for those with less than 10 years of experience (91% vs 86%; P = .03) and those with total mammographic experience of fewer than 80 000 cases (88% vs 86%; P = .03). Conclusion The addition of DBT to conventional 2D screening mammography improved specificity for all readers, but the gain in sensitivity was greater for readers with less than 10 years of experience.

A randomized controlled trial of digital breast tomosynthesis versus digital mammography in population-based screening in Bergen: interim analysis of performance indicators from the To-Be trial

“…Results from other studies indicate the need for training and workshops before reading DBT in screening [30, 31]. In our study, the radiologists’ experience in DM screen reading before the trial period varied from beginners to very experienced, the latter with more than 100,000 screen reads during their career as a breast radiologist.…”

“…A limitation of this study is the short time spent on training and workshops in DBT for radiographers before the start of the trial, which could have influenced the results in either direction [30, 31]. Moreover, we have not presented breast cancer detection data; this decision was based on per protocol power estimation, which showed that 2 years of screening—one screening round—was needed to show a 25–30% difference in the rate of screen-detected breast cancer between DBT and DM.…”

<p>The role of digital breast tomosynthesis in breast cancer screening: a manufacturer- and metrics-specific analysis</p>

“…The TOMMY trial, carried out with 7060 patients in the United Kingdom, showed a marginal increase in sensitivity with borderline significance, with the addition of DBT to DM,45 while Tucker et al, using the same data concluded that sensitivity was increased for observers with less than 10 years of experience with the addition of DBT 46…”

“…Some studies show a significantly higher specificity with the addition of DBT to DM in screening 7,36,37,42,46,48,50,51. Other studies, however, concluded that there was a non-statistically significant increase 16,39,41.…”

Translational Education

“…This is true whether it is a radiologist requesting a second opinion when reading a digital breast tomosynthesis, a paediatrician leveraging a telemedicine platform to connect a patient with an allergist to select a more targeted food allergen panel, or a rheumatologist using a virtual reality platform to simulate the selection of lab tests and discuss results with a rheumatoid arthritis patient. The implementation of these solutions could raise the level of experience of physicians, which could lead to better outcomes [6,7,8,9]. …”