Evaluation of Low-Cost Telemammography Screening Configurations: A Comparison with Film-Screen Readings in Vulnerable Areas

Abstract

The aim of this study was to evaluate the diagnostic accuracy for detecting breast cancer using different telemammography configurations, including combinations of both low-cost capture devices and consumer-grade color displays. At the same time, we compared each of these configurations to film-screen readings. This study used a treatment-by-reader-by-case factorial design. The sample included 70 mammograms with 34 malignant cases. The readers consisted of four radiologists who classified all of the cases according to the categories defined by the Breast Imaging Reporting and Data System (BI-RADS). The evaluated capture devices included a specialized film digitizer and a digital camera, and the evaluated displays included liquid crystal display (LCD) and light-emitting diode (LED) consumer-grade color displays. Receiver operating characteristic curves, diagnostic accuracy (measured as the area under these curves), accuracy of the composition classification, sensitivity, specificity, and the degree of agreement between readers in the detection of malignant cases were also evaluated. Comparisons of diagnostic accuracy between film-screen and the different combinations of digital configurations showed no significant differences for nodules, calcifications, and asymmetries. In addition, no differences were observed in terms of sensibility or specificity when the degree of malignancy using the film-screen method was compared to that provided with digital configurations. Similar results were observed for the classification of breast composition. Furthermore, all observed reader agreements of malignant detection between film-screen and digital configurations were substantial. These findings indicate that the evaluated digital devices showed comparable diagnostic accuracy to the reference treatment (film-screen).