Comparison of two-dimensional synthesized mammograms versus original digital mammograms alone and in combination with tomosynthesis images.

PURPOSE To assess interpretation performance and radiation dose when two-dimensional synthesized mammography (SM) images versus standard full-field digital mammography (FFDM) images are used alone or in combination with digital breast tomosynthesis images. MATERIALS AND METHODS A fully crossed, mode-balanced multicase (n = 123), multireader (n = 8), retrospective observer performance study was performed by using deidentified images acquired between 2008 and 2011 with institutional review board approved, HIPAA-compliant protocols, during which each patient signed informed consent. The cohort included 36 cases of biopsy-proven cancer, 35 cases of biopsy-proven benign lesions, and 52 normal or benign cases (Breast Imaging Reporting and Data System [BI-RADS] score of 1 or 2) with negative 1-year follow-up results. Accuracy of sequentially reported probability of malignancy ratings and seven-category forced BI-RADS ratings was evaluated by using areas under the receiver operating characteristic curve (AUCs) in the random-reader analysis. RESULTS Probability of malignancy-based mean AUCs for SM and FFDM images alone was 0.894 and 0.889, respectively (difference, -0.005; 95% confidence interval [CI]: -0.062, 0.054; P = .85). Mean AUC for SM with tomosynthesis and FFDM with tomosynthesis was 0.916 and 0.939, respectively (difference, 0.023; 95% CI: -0.011, 0.057; P = .19). In terms of the reader-specific AUCs, five readers performed better with SM alone versus FFDM alone, and all eight readers performed better with combined FFDM and tomosynthesis (absolute differences from 0.003 to 0.052). Similar results were obtained by using a nonparametric analysis of forced BI-RADS ratings. CONCLUSION SM alone or in combination with tomosynthesis is comparable in performance to FFDM alone or in combination with tomosynthesis and may eliminate the need for FFDM as part of a routine clinical study.

[1]  David Gur,et al.  Detection and classification of calcifications on digital breast tomosynthesis and 2D digital mammography: a comparison. , 2011, AJR. American journal of roentgenology.

[2]  Andriy I. Bandos,et al.  Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. , 2013, Radiology.

[3]  Andriy I. Bandos,et al.  Prospective trial comparing full-field digital mammography (FFDM) versus combined FFDM and tomosynthesis in a population-based screening programme using independent double reading with arbitration , 2013, European Radiology.

[4]  David Gur,et al.  Dose reduction in digital breast tomosynthesis (DBT) screening using synthetically reconstructed projection images: an observer performance study. , 2012, Academic radiology.

[5]  N Houssami,et al.  Application of breast tomosynthesis in screening: incremental effect on mammography acquisition and reading time. , 2012, The British journal of radiology.

[6]  Paolo Peterlongo,et al.  Prospective study of breast tomosynthesis as a triage to assessment in screening , 2012, Breast Cancer Research and Treatment.

[7]  David Gur,et al.  Digital breast tomosynthesis: observer performance study. , 2009, AJR. American journal of roentgenology.

[8]  Tor D Tosteson,et al.  Digital breast tomosynthesis: initial experience in 98 women with abnormal digital screening mammography. , 2007, AJR. American journal of roentgenology.

[9]  D. Kopans,et al.  Digital tomosynthesis in breast imaging. , 1997, Radiology.

[10]  David Gur,et al.  Localized detection and classification of abnormalities on FFDM and tomosynthesis examinations rated under an FROC paradigm. , 2011, AJR. American journal of roentgenology.

[11]  Gisella Gennaro,et al.  Digital breast tomosynthesis versus digital mammography: a clinical performance study , 2010, European Radiology.

[12]  I. Sechopoulos.  A review of breast tomosynthesis. Part I. The image acquisition process. , 2013, Medical physics.

[13]  Unni Haakenaasen,et al.  Digital breast tomosynthesis (DBT): initial experience in a clinical setting , 2012, Acta radiologica.

[14]  E. Halpern,et al.  Assessing radiologist performance using combined digital mammography and breast tomosynthesis compared with digital mammography alone: results of a multicenter, multireader trial. , 2013, Radiology.

[15]  S. Vecchio,et al.  A novel approach to digital breast tomosynthesis for simultaneous acquisition of 2D and 3D images , 2011, European Radiology.

[16]  David Gur,et al.  Digital breast tomosynthesis versus supplemental diagnostic mammographic views for evaluation of noncalcified breast lesions. , 2013, Radiology.

[17]  T. Kahn,et al.  Average Glandular Dose in Digital Mammography and Breast Tomosynthesis , 2012, Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren.

[18]  David Gur,et al.  Time to diagnosis and performance levels during repeat interpretations of digital breast tomosynthesis: preliminary observations. , 2010, Academic radiology.

[19]  S. Rose,et al.  Implementation of breast tomosynthesis in a routine screening practice: an observational study. , 2013, AJR. American journal of roentgenology.