European Radiology

, Volume 23, Issue 3, pp 664–672

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


    • Veneto Institute of Oncology (IOV)–IRCCS
  • R. Edward Hendrick
    • Department of RadiologyUniversity of Colorado-Denver, School of Medicine
  • Patricia Ruppel
    • Innovative Analytics
  • Roberta Chersevani
    • Private Clinical Practice
  • Cosimo di Maggio
    • Private Clinical Practice
  • Manuela La Grassa
    • Oncological Reference Center (CRO)–IRCCS
  • Luigi Pescarini
    • Veneto Institute of Oncology (IOV)–IRCCS
  • Ilaria Polico
    • Veneto Institute of Oncology (IOV)–IRCCS
  • Alessandro Proietti
    • Veneto Institute of Oncology (IOV)–IRCCS
  • Enrica Baldan
    • Veneto Institute of Oncology (IOV)–IRCCS
  • Elisabetta Bezzon
    • Veneto Institute of Oncology (IOV)–IRCCS
  • Fabio Pomerri
    • Veneto Institute of Oncology (IOV)–IRCCS
  • Pier Carlo Muzzio
    • Veneto Institute of Oncology (IOV)–IRCCS

DOI: 10.1007/s00330-012-2649-1

Cite this article as:
Gennaro, G., Hendrick, R.E., Ruppel, P. et al. Eur Radiol (2013) 23: 664. doi:10.1007/s00330-012-2649-1



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 tomosynthesisMammographyTomographyClinical performanceReceiver-operating characteristics

Copyright information

© European Society of Radiology 2012