One view or two views for wide-angle tomosynthesis with synthetic mammography in the assessment setting?

Abstract

Objectives To evaluate the diagnostic performance in the assessment setting of three protocols: one-view wide-angle digital breast tomosynthesis (WA-DBT) with synthetic mammography (SM), two-view WA-DBT/SM, and two-view digital mammography (DM). Methods Included in this retrospective study were patients who underwent bilateral two-view DM and WA-DBT. SM were reconstructed from the WA-DBT data. The standard of reference was histology and/or 2 years follow-up. Included were 205 women with 179 lesions (89 malignant, 90 benign). Four blinded readers randomly evaluated images to assess density, lesion type, and level of suspicion according to BI-RADS. Three protocols were evaluated: two-view DM, one-view (mediolateral oblique) WA-DBT/SM, and two-view WA-DBT/SM. Detection rate, sensitivity, specificity, and accuracy were calculated and compared using multivariate analysis. Reading time was assessed. Results The detection rate was higher with two-view WA-DBT/SM (p = 0.063). Sensitivity was higher for two-view WA-DBT/SM compared to two-view DM (p = 0.001) and one-view WA-DBT/SM (p = 0.058). No significant differences in specificity were found. Accuracy was higher with both one-view WA-DBT/SM and two-view WA-DBT/SM compared to DM (p = 0.003 and > 0.001, respectively). Accuracy did not differ between one- and two-view WA-DBT/SM. Two-view WA-DBT/SM performed better for masses and asymmetries. Reading times were significantly longer when WA-DBT was evaluated. Conclusions One-view and two-view WA-DBT/SM can achieve a higher diagnostic performance compared to two-view DM. The detection rate and sensitivity were highest with two-view WA-DBT/SM. Two-view WA-DBT/SM appears to be the most appropriate tool for the assessment of breast lesions. Key Points • Detection rate with two-view wide-angle digital breast tomosynthesis (WA-DBT) is significantly higher than with two-view digital mammography in the assessment setting. • Diagnostic accuracy of one-view and two-view WA-DBT with synthetic mammography (SM) in the assessment setting is higher than that of two-view digital mammography. • Compared to one-view WA-DBT with SM, two-view WA-DBT with SM seems to be the most appropriate tool for the assessment of breast lesions.

Breast cancer screening with digital breast tomosynthesis: comparison of different reading strategies implementing artificial intelligence

“…Apart from radiation dose, the major remaining obstacle to implementing full DBT screening is the increased workload caused by longer reading time. In previous studies, the reading time for two-view DBT was 38-76% longer than for DM [7][8][9][10][11].…”

“…Different AI score thresholds were evaluated. Special focus was placed on a threshold where 50% of the examinations would be excluded, giving an unchanged screening workload compared to DM screening (conservative assumption of DBT reading time twice as long as DM [7][8][9][10][11]). B.…”

“…One-view wide-angle DBT screening reduces the interval cancer rate, which is often used as a surrogate measure for breast cancer mortality [ 6 ]. Many studies also suggest the use of two-view DBT, which avoids the risk of any information only available in the CC-view being lost and can result in an even higher sensitivity, although it can have a higher radiation dose than DM [ 2 , 3 , 7 , 8 ]. However, a slightly higher dose might be acceptable if it meant a gain in sensitivity.…”