Assessing Radiologist Performance Using Combined Digital Mammography and Breast Tomosynthesis Compared with Digital Mammography Alone: Results of a Multicenter, Multireader Trial

Abstract

Purpose:To compare radiologists' diagnostic accuracy and recall rates for breast tomosynthesis combined with digital mammography versus digital mammography alone. Materials and Methods:Institutional review board approval was obtained at each accruing institution. Participating women gave written informed consent. Mediolateral oblique and craniocaudal digital mammographic and tomosynthesis images of both breasts were obtained from 1192 subjects. Two enriched reader studies were performed to compare digital mammography with tomosynthesis against digital mammography alone. Study 1 comprised 312 cases (48 cancer cases) with images read by 12 radiologists; study 2, 312 cases (51 cancer cases) with 15 radiologists. Study 1 readers recorded only that an abnormality requiring recall was present; study 2 readers had additional training and recorded both lesion type and location. Diagnostic accuracy was compared with receiver operating characteristic analysis. Recall rates of noncancer cases, sensitivity, specificity, and positive and negative predictive values determined by analyzing Breast Imaging Reporting and Data System scores were compared for the two methods. Results:Diagnostic accuracy for combined tomosynthesis and digital mammography was superior to that of digital mammography alone. Average difference in area under the curve in study 1 was 7.2% (95% confidence interval [CI]: 3.7%, 10.8%; P , .001) and in study 2 was 6.8% (95% CI: 4.1%, 9.5%; P , .001). All 27 radiologists increased diagnostic accuracy with addition of tomosynthesis. Recall rates for noncancer cases for all readers significantly decreased with addition of tomosynthesis (range, 6%-67%; P , .001 for 25 readers, P , .03 for all readers). Increased sensitivity was largest for invasive cancers: 15% and 22% in studies 1 and 2 versus 3% for in situ cancers in both studies. Conclusion:Addition of tomosynthesis to digital mammography offers the dual benefit of significantly increased diagnostic accuracy and significantly reduced recall rates for noncancer cases.q RSNA, 2012 Supplemental material: http://radiology.rsna.org/lookup /suppl

Quantra™ should be considered a tool for two-grade scale mammographic breast density classification

“…8,9 Therefore, adding breast density information to existing breast cancer riskprediction models may improve the stratification of breast cancer risk, 10 which may lead to earlier adoption of prevention and control measures. Breast density information can also be used for tailoring clinical decisions such as screening intervals for females who are asymptomatic and the selection of more appropriate imaging pathways such as ultrasound, 11 MRI 12 or digital breast tomosynthesis (DBT) 13 to enhance the visualization and evaluation of the dense tissue for features of cancer. 14 Currently, breast density notification laws are effective in 22 US states, and the most economically viable and common method of obtaining such information is through mammographic breast density (MBD) assessment.…”

Breast composition: Measurement and clinical use

“…Also, since 50% of interval breast cancer is attributed to high mammographic breast density, 3 it is essential to assess breast density of screened women in order to identify women who may need to be screened more regularly. Existing evidence shows that ultrasound, 29,30 digital breast tomosynthesis, 31 or MRI 30 improves cancer detection in dense breasts although it remains unclear which one suits which breasts best.…”

“…148,149 Studies have reported 7.2% -53% increase in cancer detection and 20% -59% reduction in recall rates with supplemental DBT. 31,44,45,150,151 Importantly, radiation dose to the dense tissue is lower for DBT than digital mammography (DM) for dense breasts; 43 therefore DBT is preferable to DM in terms of performance and dose, albeit it appears women with fatty breasts get higher dose on DBT. 152 Another approach suitable for imaging the dense breast is molecular breast imaging (MBI) or BreastSpecific Gamma Imaging (BSGI).…”

“…This will allow for shared decision-making between screened women and their physicians concerning strategies to reduce the associated risks and facilitate better decisions regarding screening. 17,19,27 National level breast density information will enable breast cancer risk stratification, 27,28 leading to selection of appropriate imaging pathways such as ultrasound, 29,30 digital breast tomosynthesis (DBT), 31 and magnetic resonance imaging (MRI) 30 to improve cancer detection in the dense breast.…”

Detection of microcalcification clusters by 2D-mammography and narrow and wide angle digital breast tomosynthesis

“…It has been shown that DBT increases the detectability of masses in the breast and reduces recalls when used in combination with 2D-mammography in screening [1]. Some studies have shown that detectability of microcalcifications with DBT is slightly lower than with 2D-mammography, whereas others have claimed the converse is true [2][3].…”