Radiologists' interpretive efficiency and variability in true- and false-positive detection when screen-reading with tomosynthesis (3D-mammography) relative to standard mammography in population screening

Abstract

We examined interpretive efficiency and variability in true- and false-positive detection (TP, FP) for radiologists screen-reading with digital breast tomosynthesis as adjunct to full-field digital mammography (2D/3D) relative to 2D alone in population-based screening studies. A systematic literature search was performed to identify screening studies that provided radiologist-specific data for TP and FP detection. Radiologist interpretive efficiency (trade-off between TPs and FPs) was calculated using the FP:TP ratio which expresses the number of FP recalls for each screen-detected breast cancer. We modeled a pooled FP:TP ratio to assess variability in radiologists' interpretive efficiency at study-level using random effects logistic regression. FP:TP ratio improved (ratio decreased) for 2D/3D screen-reading (relative to 2D) for a majority of radiologists (18 of 22) across all studies. Variability in radiologists' FP:TP ratio was consistently lower in all studies for 2D/3D screen-reading, as suggested by lower variance in ratios. Study-level pooled FP:TP ratio for 2D- and 2D/3D-mammography respectively, were 5.96 (95%CI: 4.08 to 8.72) and 3.17 (95%CI: 2.25 to 4.47) for the STORM trial; 10.25 (95%CI: 6.42 to 16.35) and 7.07 (95%CI: 4.99 to 10.02) for the Oslo trial; and 20.84 (95%CI: 13.95 to 31.12) and 8.37 (95%CI: 5.87 to 11.93) for the Houston study. This transfers into study-level improved interpretative efficiencies of 48%, 30% and 55%, respectively, for 2D/3D screen-reading (relative to 2D). In summary, study-level FP:TP trade-off improved using 2D/3D-mammography for all studies, which was also seen for most individual radiologists. There was variability in the FP:TP trade-off between readers and studies for 2D-as well as for 2D/3D-interpretations but variability in radiologists' interpretive efficiency was relatively lower using 2D/3D-mammography.

Clinical performance of Siemens digital breast tomosynthesis versus standard supplementary mammography for the assessment of screen-detected soft-tissue abnormalities: a multi-reader study

“…We could speculate that the "biopsy/no biopsy" classification may have depressed specificity in our study, and that some low levels of experience among the readers may have affected confidence to state "no biopsy". It is well recognised that the sensitivity-specificity trade-off varies between readers 18 . A Swedish trial of one-view Siemens DBT versus FFDM in the primary screening context has found lower specificity alongside higher sensitivity, particularly in the early stages of the study when reader experience was lower 19 .…”

An overview of kidney stone imaging techniques

“…This procedure enables visualization of stones from multiple angles rather than simply anterior to posterior, and has been used extensively in breast imaging as an alternative screening modality for mammography 54–56 . For patients with kidney stones, imaging at multiple angles improves sensitivity and specificity with scant increases in radiation exposure 57,58 .…”

Near-Field Radar Microwave Imaging as an Add-on Modality to Mammography

“…One year later, Svahns et al considered the FP to TP ratios in three populationbased studies and reported improvements in radiologists' interpretive efficacy of X-ray images when a combined configuration was implemented. The results indicated 55, 48 and 30% improvement in true positive detection when a 2D-3D setup was used in lieu of traditional setup in Houston, STORM, and Oslo studies, severally [48]. In TOMMY trial in UK, 2015, increased specificity (by 9%) for all studied groups and elevated sensitivity (by 7%) for dense breasts was observed as a result of using digital and film screening [49].…”