European Radiology

, Volume 23, Issue 3, pp 664–672 | Cite as

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

  • Gisella Gennaro
  • R. Edward Hendrick
  • Patricia Ruppel
  • Roberta Chersevani
  • Cosimo di Maggio
  • Manuela La Grassa
  • Luigi Pescarini
  • Ilaria Polico
  • Alessandro Proietti
  • Enrica Baldan
  • Elisabetta Bezzon
  • Fabio Pomerri
  • Pier Carlo Muzzio
Breast

Abstract

Objective

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.

Methods

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.

Results

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).

Conclusion

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.

Keywords

Breast tomosynthesis Mammography Tomography Clinical performance Receiver-operating characteristics 

Notes

Acknowledgments

The authors would like to thank L. Katz, F. Braga, L. Hernandez, H. Souchay, R. Iordache, A. Talaverano and Sylvain Bernard from GE Healthcare for helpful discussion and scientific debate. They are also grateful to Andrea Azzalini for his help in figure preparation.

R. Edward Hendrick and Patricia Ruppel are consultants to GE Healthcare.

References

  1. 1.
    Niklason LT, Christian BT, Niklason LE et al (1997) Digital tomosynthesis in breast imaging. Radiology 205:399–406PubMedGoogle Scholar
  2. 2.
    Park JM, Franken EA Jr, Garg M, Fajardo LL, Niklason LT (2007) Breast tomosynthesis: present considerations and future applications. Radiographics 27:S231–S240PubMedCrossRefGoogle Scholar
  3. 3.
    Rafferty E (2007) Digital mammography: novel applications. Radiol Clin N Am 45:831–843PubMedCrossRefGoogle Scholar
  4. 4.
    Good WF, Abrams GS, Catullo VJ et al (2008) Digital breast tomosynthesis: a pilot observer study. AJR Am J Roentgenol 190:865–869PubMedCrossRefGoogle Scholar
  5. 5.
    Andersson I, Ikeda DM, Zackrisson S et al (2008) Breast tomosynthesis and digital mammography: a comparison of breast cancer visibility and BIRADS classification in a population of cancers with subtle mammographic findings. Eur Radiol 18:2817–2825PubMedCrossRefGoogle Scholar
  6. 6.
    Gur D, Abrams GS, Chough DM et al (2009) Digital breast tomosynthesis: observer performance study. AJR Am J Roentgenol 193:586–591PubMedCrossRefGoogle Scholar
  7. 7.
    Teertstra HJ, Loo CE, van den Bosch MAAJ et al (2010) Breast tomosynthesis in clinical practice. Eur Radiol 20:16–24PubMedCrossRefGoogle Scholar
  8. 8.
    Gennaro G, Toledano A, di Maggio C et al (2010) Digital breast tomosynthesis versus digital mammography: a clinical performance study. Eur Radiol 20:1545–1553PubMedCrossRefGoogle Scholar
  9. 9.
    Svahn TM, Chakraborty DP, Ikeda D, Zackrisson S, Do Y, Mattsson S, Andersson I. Breast tomosynthesis and digital mammography: a comparison of diagnostic accuracy. Br J Radiol. 2012 Jun 6. [Epub ahead of print] PubMed PMID: 22674710Google Scholar
  10. 10.
    Wallis MG, Moa E, Zanca F, Leifland K, Danielsson M (2012) Two-view and single-view tomosynthesis versus full-field digital mammography: high-resolution x-ray imaging observer study. Radiology 262:788–796PubMedCrossRefGoogle Scholar
  11. 11.
    Gur D, Bandos AI, Rockette HE et al (2011) Localized detection and classification of abnormalities on FFDM and tomosynthesis examinations rated under an FROC paradigm. Am J Roentgenol 196:737–741CrossRefGoogle Scholar
  12. 12.
    Svahn T, Andersson I, Chakraborty D et al (2010) The diagnostic accuracy of dual-view digital mammography, single-view tomosynthesis and a dual-view combination of breast tomosynthesis and digital mammography in a free-response observer performance study. Radiat Prot Dosim 139:113–117CrossRefGoogle Scholar
  13. 13.
    Michell MJ, Iqbal A, Wasan RK, Evans DR, Peacock C, Lawinski CP, Douiri A, Wilson R, Whelehan P. A comparison of the accuracy of film-screen mammography, full-field digital mammography and digital breast tomosynthesis. Clin Radiol. 2012 May 23. [Epub ahead of print] PubMed PMID: 22625656Google Scholar
  14. 14.
    Wu T, Liu B, Moore R, Kopans D (2006) Optimal acquisition techniques for digital breast tomosynthesis screening. In: Flynn MJ, Hsieh J (ed) Medical imaging 2006: physics of medical imaging. Proceedings of SPIE 2006;6142:61425-EGoogle Scholar
  15. 15.
    Sechopoulos I, Suryanarayanan S, Vedhantam S, D'Orsi C, Karellas A (2007) Computation of the glandular radiation dose in digital tomosynthesis of the breast. Med Phys 34:232–331Google Scholar
  16. 16.
    Dance DR, Young KC, van Engen RE (2011) Estimation of mean glandular dose for breast tomosynthesis: factors for use with the UK, European and IAEA breast dosimetry protocols. Phys Med Biol 56:453–471PubMedCrossRefGoogle Scholar
  17. 17.
    American College of Radiology (ACR) (2003) Breast imaging reporting and data system Atlas (BI-RADS® Atlas). © American College of Radiology, RestonGoogle Scholar
  18. 18.
    Pesce LL, Metz CE (2007) Reliable and computationally efficient maximum likelihood estimation of “proper” binormal ROC curves. Acad Radiol 14:814–829PubMedCrossRefGoogle Scholar
  19. 19.
    Obuchowski NA (2007) New methodological tools for multiple-reader ROC studies. Radiology 243:10–12PubMedCrossRefGoogle Scholar
  20. 20.
    Obuchowski NA (1995) Multireader, multimodality receiver operating characteristic curve studies: hypothesis testing and sample size estimation using an analysis of variance approach with dependent observations. Acad Radiol 2:S22–S29PubMedCrossRefGoogle Scholar
  21. 21.
    Obuchowski NA (1997) Testing for equivalence of diagnostic tests. AJR Am J Roentgenol 168:13–17PubMedGoogle Scholar
  22. 22.
    Hillis SL (2007) A comparison of denominator degrees of freedom methods for multiple observer ROC analysis. Stat Med 26:596–619PubMedCrossRefGoogle Scholar
  23. 23.
    Pater C (2004) Equivalence and noninferiority trials–are they viable alternatives for registration of new drugs ? (III). Curr Control Trials Cardiovasc Med 5:8–14PubMedCrossRefGoogle Scholar
  24. 24.
    Vecchio S, Albanese A, Vignoli P, Taibi A (2011) A novel approach to digital breast tomosynthesis for simultaneous acquisition of 2D and 3D images. Eur Radiol 21:1207–1213PubMedCrossRefGoogle Scholar
  25. 25.
    Spangler ML, Zuley ML, Sumkin JH et al (2010) Detection and classification of calcifications on digital breast tomosynthesis and 2D digital mammography: a comparison. AJR Am J Roentgenol 196:320–324CrossRefGoogle Scholar
  26. 26.
    Kopans D, Gavenonis S, Halpern E, Moore R (2011) Calcifications in the breast and digital breast tomosynthesis. Breast J 6:638–644CrossRefGoogle Scholar
  27. 27.
    Chakrabarti K, Ochs R, Pennello G, Samuelson F. P080003 Hologic Selenia dimension 3D system. FDA executive summary September 2010, http://www.fda.gov.downloads.AdvisoryCommittees/CommitteesMeetingMaterial/MedicalDevices/MedicalDevicesAdvisoryCommittee/RadiologicalDevicesPanel/UCM226757.pdf. Accessed July 3, 2011
  28. 28.
    Gur D, Bandos AI, Cohen CS et al (2008) The “laboratory” effect: comparing radiologists’ performance and variability during prospective clinical and laboratory mammography interpretations. Radiology 249:47–53PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Gisella Gennaro
    • 1
  • R. Edward Hendrick
    • 2
  • Patricia Ruppel
    • 3
  • Roberta Chersevani
    • 4
  • Cosimo di Maggio
    • 5
  • Manuela La Grassa
    • 6
  • Luigi Pescarini
    • 1
  • Ilaria Polico
    • 1
  • Alessandro Proietti
    • 1
  • Enrica Baldan
    • 1
  • Elisabetta Bezzon
    • 1
  • Fabio Pomerri
    • 1
  • Pier Carlo Muzzio
    • 1
  1. 1.Veneto Institute of Oncology (IOV)–IRCCSPaduaItaly
  2. 2.Department of RadiologyUniversity of Colorado-Denver, School of MedicineAuroraUSA
  3. 3.Innovative AnalyticsKalamazooUSA
  4. 4.Private Clinical PracticeGoriziaItaly
  5. 5.Private Clinical PracticePaduaItaly
  6. 6.Oncological Reference Center (CRO)–IRCCS(Pordenone)Italy

Personalised recommendations