Diagnostic accuracy of digital mammography versus tomosynthesis: effect of radiologists' experience

Purpose: To investigate whether readers' experience affects performance in a study comparing 2D digital mammography (2D) with 2-view (CC and MLO) or 1-view (MLO) tomosynthesis. Materials and Methods: One-hundred-thirty 2D cases were collected from screening assessment and referral clinics; 64 of the cases had verified abnormalities and the remaining were confirmed normal. Two-view tomosynthesis images were obtained from the same patients. Ten accredited readers (5 with ≥ 10 years experience in mammography and 5 with < 10 years) classified the cases in terms of malignancy (rate 0-5), and recall (yes/no), for both modalities. A second experiment was performed with the same cases, with 10 other readers (again 5 experienced / 5 less experienced), but using 2D and 1-view tomosynthesis as the two modalities. The multi-reader-multi-case ROC method was applied and the significance of diagnostic accuracy difference of 2D vs tomosynthesis was calculated, as a function of experience and for each experiment. Recall rate (RR) on malignant and benign cases was also calculated, along with reading time. Results: No significant difference was reached between 2D and 2-view tomosynthesis for experienced readers (pvalue= 0.25); for less experienced readers the p-value was significant (0.03). No significant difference was found between 2D and 1-view tomosynthesis, independent of readers' experience. RR for benign cases decreased for tomosynthesis (for booth 1- and 2-view), independent of experience. Average reading time per case was 79 s (range 65- 91 s) and 134 s (range 119-158 s) for experienced readers; 56 s (range 46-67 s) and 115s (range 97-142 s) for nonexperienced, for 2D and 2-view tomosynthesis respectively. Reading time was 74 s (range 43-98 s) and 99 s (range 73- 117 s) for experienced readers; 74 s (range 62-85 s) and 94 s (range 82-137 s) for non-experienced, for 2D and 1-view tomosynthesis respectively. Conclusions: For experienced readers, there is no evidence of improved diagnostic accuracy when using 2-view or 1- view tomosynthesis, while less experienced readers perform better with 2-view tomosynthesis than 2D images. Tomosynthesis reduces the number of recall of benign cases, without hindering cancer detection.