European Radiology

, Volume 23, Issue 3, pp 664-672

First online:

Performance comparison of single-view digital breast tomosynthesis plus single-view digital mammography with two-view digital mammography

  • Gisella GennaroAffiliated withVeneto Institute of Oncology (IOV)–IRCCS Email author 
  • , R. Edward HendrickAffiliated withDepartment of Radiology, University of Colorado-Denver, School of Medicine
  • , Patricia RuppelAffiliated withInnovative Analytics
  • , Roberta ChersevaniAffiliated withPrivate Clinical Practice
  • , Cosimo di MaggioAffiliated withPrivate Clinical Practice
  • , Manuela La GrassaAffiliated withOncological Reference Center (CRO)–IRCCS
  • , Luigi PescariniAffiliated withVeneto Institute of Oncology (IOV)–IRCCS
  • , Ilaria PolicoAffiliated withVeneto Institute of Oncology (IOV)–IRCCS
  • , Alessandro ProiettiAffiliated withVeneto Institute of Oncology (IOV)–IRCCS
    • , Enrica BaldanAffiliated withVeneto Institute of Oncology (IOV)–IRCCS
    • , Elisabetta BezzonAffiliated withVeneto Institute of Oncology (IOV)–IRCCS
    • , Fabio PomerriAffiliated withVeneto Institute of Oncology (IOV)–IRCCS
    • , Pier Carlo MuzzioAffiliated withVeneto Institute of Oncology (IOV)–IRCCS

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To determine the performance of combined single-view mediolateral oblique (MLO) digital breast tomosynthesis (DBT) plus single-view cranio-caudal (CC) mammography (MX) compared with that of standard two-view digital mammography.


A multi-reader multi-case (MRMC) receiver-operating characteristic (ROC) study was conducted, involving six breast radiologists. Two hundred fifty patients underwent bilateral MX and DBT imaging. MX and DBT images with the adjunct of the CC-MX view from 469 breasts were evaluated and rated independently by six readers. Differences in mean areas under the ROC curves (AUCs), mean sensitivity and mean specificity were analysed by analysis of variance (ANOVA) to assess clinical performance.


The combined technique was found to be non-inferior to standard two-view mammography (MX(CC+MLO)) in mean AUC (difference: +0.021;95 % LCL = −0.011), but was not statistically significant for superiority (P = 0.197). The combined technique had equivalent sensitivity to standard mammography (76.2 % vs. 72.8 %, P = 0.269) and equivalent specificity (84.9 % vs. 83.0 %, P = 0.130). Specificity for benign lesions was significantly higher with the combination of techniques versus mammography (45.6 % vs. 36.8 %, P = 0.002).


In this enriched study population, the combination of single-view MLO tomosynthesis plus single-view CC mammography was non-inferior to that of standard two-view digital mammography in terms of ROC curve area, sensitivity and specificity.

Key Points

• Breast tomosynthesis (DBT) has emerged as a valuable adjunct to mammography (MX).

• Combination DBT/MX demonstrated non-inferior clinical performance to standard two-view MX.

• Combination DBT/MX was superior to two-view MX in recognising benign lesions.

• Combination DBT/MX reduced variability compared with two-view MX.


Breast tomosynthesis Mammography Tomography Clinical performance Receiver-operating characteristics