Breast tomosynthesis and digital mammography: a comparison of diagnostic accuracy.

OBJECTIVE Our aim was to compare the ability of radiologists to detect breast cancers using one-view breast tomosynthesis (BT) and two-view digital mammography (DM) in an enriched population of diseased patients and benign and/or healthy patients. METHODS All participants gave informed consent. The BT and DM examinations were performed with about the same average glandular dose to the breast. The study population comprised patients with subtle signs of malignancy seen on DM and/or ultrasonography. Ground truth was established by pathology, needle biopsy and/or by 1-year follow-up by mammography, which retrospectively resulted in 89 diseased breasts (1 breast per patient) with 95 malignant lesions and 96 healthy or benign breasts. Two experienced radiologists, who were not participants in the study, determined the locations of the malignant lesions. Five radiologists, experienced in mammography, interpreted the cases independently in a free-response study. The data were analysed by the receiver operating characteristic (ROC) and jackknife alternative free-response ROC (JAFROC) methods, regarding both readers and cases as random effects. RESULTS The diagnostic accuracy of BT was significantly better than that of DM (JAFROC: p=0.0031, ROC: p=0.0415). The average sensitivity of BT was higher than that of DM (∼90% vs ∼79%; 95% confidence interval of difference: 0.036, 0.108) while the average false-positive fraction was not significantly different (95% confidence interval of difference: -0.117, 0.010). CONCLUSION The diagnostic accuracy of BT was superior to DM in an enriched population.

[1]  D Laming,et al.  Improving the detection of cancer in the screening of mammograms , 2000, Journal of medical screening.

[2]  C. D'Orsi,et al.  Computation of the glandular radiation dose in digital tomosynthesis of the breast. , 2006, Medical physics.

[3]  A. Burgess,et al.  Human observer detection experiments with mammograms and power-law noise. , 2001, Medical physics.

[4]  Andrew P. Smith,et al.  Clinical Performance of Breast Tomosynthesis as a Function of Radiologist Experience Level , 2008, Digital Mammography / IWDM.

[5]  David Gur,et al.  Digital breast tomosynthesis: a pilot observer study. , 2008, AJR. American journal of roentgenology.

[6]  Jean B. Cormack,et al.  Diagnostic accuracy of digital versus film mammography: exploratory analysis of selected population subgroups in DMIST. , 2008, Radiology.

[7]  John M. Boone,et al.  Computed Tomography for Imaging the Breast , 2006, Journal of Mammary Gland Biology and Neoplasia.

[8]  Magnus Båth,et al.  VIEWDEX: an efficient and easy-to-use software for observer performance studies. , 2010, Radiation protection dosimetry.

[9]  D. Chakraborty.  New developments in observer performance methodology in medical imaging. , 2011, Seminars in nuclear medicine.

[10]  Anders Tingberg,et al.  Breast tomosynthesis and digital mammography: a comparison of breast cancer visibility and BIRADS classification in a population of cancers with subtle mammographic findings , 2008, European Radiology.

[11]  Willi A. Kalender.  Concepts for High-Resolution CT of the Breast , 2010, Digital Mammography / IWDM.

[12]  F R Verdun,et al.  Estimation of the noisy component of anatomical backgrounds. , 1999, Medical physics.

[13]  Thomas Mertelmeier,et al.  Experimental validation of a three-dimensional linear system model for breast tomosynthesis. , 2008, Medical physics.

[14]  Magnus Båth,et al.  ViewDEX 2.0: a Java-based DICOM-compatible software for observer performance studies , 2009, Medical Imaging.

[15]  P. Skaane.  Studies comparing screen-film mammography and full-field digital mammography in breast cancer screening: Updated review , 2009, Acta radiologica.

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

[17]  Dev P Chakraborty,et al.  Recent advances in observer performance methodology: jackknife free-response ROC (JAFROC). , 2005, Radiation protection dosimetry.

[18]  I Andersson,et al.  The diagnostic accuracy of dual-view digital mammography, single-view breast tomosynthesis and a dual-view combination of breast tomosynthesis and digital mammography in a free-response observer performance study. , 2010, Radiation protection dosimetry.

[19]  Anders Tingberg,et al.  Breast tomosynthesis: Accuracy of tumor measurement compared with digital mammography and ultrasonography , 2010, Acta radiologica.

[20]  D P Chakraborty.  A search model and figure of merit for observer data acquired according to the free-response paradigm. , 2006, Physics in medicine and biology.

[21]  V. Beral,et al.  Breast cancer histological classification: agreement between the Office for National Statistics and the National Health Service Breast Screening Programme , 2005, Breast Cancer Research.

[22]  Kenneth G. A. Gilhuijs,et al.  Breast tomosynthesis in clinical practice: initial results , 2009, European Radiology.

[23]  H. Helenius,et al.  Significant improvement in breast cancer survival through population-based mammography screening. , 2003, Breast.

[24]  Thomas Mertelmeier,et al.  Optimizing filtered backprojection reconstruction for a breast tomosynthesis prototype device , 2006, SPIE Medical Imaging.

[25]  Sara Gavenonis,et al.  Calcifications in the Breast and Digital Breast Tomosynthesis , 2011, The breast journal.

[26]  L. Liberman,et al.  Breast imaging reporting and data system (BI-RADS). , 2002, Radiologic clinics of North America.

[27]  MJ Michell,et al.  Two-view 2D digital mammography versus one-view digital breast tomosynthesis , 2010, Breast Cancer Research.

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

[29]  David Gur,et al.  "Memory effect" in observer performance studies of mammograms. , 2005, Academic radiology.

[30]  Xiao-Hua Zhou,et al.  Statistical Methods in Diagnostic Medicine , 2002 .

[31]  Joseph Y. Lo,et al.  Digital breast tomosynthesis using an amorphous selenium flat panel detector , 2005, SPIE Medical Imaging.

[32]  T. M. Kolb,et al.  Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. , 2002, Radiology.

[33]  P. Silcocks,et al.  What is the lifetime risk of developing cancer?: the effect of adjusting for multiple primaries , 2011, British Journal of Cancer.

[34]  Dev P Chakraborty,et al.  Observer studies involving detection and localization: modeling, analysis, and validation. , 2004, Medical physics.

[35]  I. Andersson,et al.  Invasive lobular carcinoma: mammographic findings in a 10-year experience. , 1991, Radiology.

[36]  K. Berbaum,et al.  Receiver operating characteristic rating analysis. Generalization to the population of readers and patients with the jackknife method. , 1992, Investigative radiology.

[37]  C E Metz,et al.  Some practical issues of experimental design and data analysis in radiological ROC studies. , 1989, Investigative radiology.

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

[39]  J. Boone,et al.  Dedicated breast CT: initial clinical experience. , 2008, Radiology.

[40]  C. Metz,et al.  "Proper" Binormal ROC Curves: Theory and Maximum-Likelihood Estimation. , 1999, Journal of mathematical psychology.

[41]  David Gur,et al.  Prevalence effect in a laboratory environment. , 2003, Radiology.