Comparing two visualization protocols for tomosynthesis in screening: specificity and sensitivity of slabs versus planes plus slabs
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Tomosynthesis (DBT) has proven to be more sensitive than digital mammography, but it requires longer reading time. We retrospectively compared accuracy and reading times of a simplified protocol with 1-cm-thick slabs versus a standard protocol of slabs + 1-mm-spaced planes, both integrated with synthetic 2D.
We randomly selected 894 DBTs (including 12 cancers) from the experimental arm of the RETomo trial. DBTs were read by two radiologists to estimate specificity. A second set of 24 cancers (8 also present in the first set) mixed within 276 negative DBTs was read by two radiologists. In total, 28 cancers with 64 readings were used to estimate sensitivity. Radiologists read with both protocols separated by a 3-month washout. Only women that were positive at the screening reading were assessed. Variance was estimated taking into account repeated measures.
Sensitivity was 82.8% (53/64, 95% confidence interval (95% CI) 67.2–92.2) and 90.6% (95% CI 80.2–95.8) with simplified and standard protocols, respectively. In the random screening setting, specificity was 97.9% (1727/1764, 95% CI 97.1–98.5) and 96.3% (95% CI 95.3–97.1), respectively. Inter-reader agreement was 0.68 and 0.54 with simplified and standard protocols, respectively. Median reading times with simplified protocol were 20% to 30% shorter than with standard protocol.
A simplified protocol reduced reading time and false positives but may have a negative impact on sensitivity.
• The adoption of digital breast tomosynthesis (DBT) in screening, more sensitive than mammography, could be limited by its potential effect on the radiologists’ workload, i.e., increased reading time and fatigue.
• A DBT simplified protocol with slab only, compared to a standard protocol (slab plus planes) both integrated with synthetic 2D, reduced time and false positives but had a negative impact on sensitivity.
KeywordsBreast neoplasms Mass screening Mammography Workflow Sensitivity and specificity
Arcispedale Santa Maria Nuova
Azienda Unità Sanitaria Locale
Breast imaging-reporting and data system
Initials of reader 1
Digital breast tomosynthesis
Ductal carcinoma in situ
Food and Drug Administration
Istituto di Ricovero e Cura a Carattere Scientifico (Research Hospital)
Picture archiving and communication system
Initials of reader 2
Initials of reader 3
Many thanks to all the personnel for their committed work during data collection and to all women who participated in the study for their fundamental contribution. We want to sincerely thank Carlo Alberto Mori, MD, for his precious support, devoted work for this study, and inestimable experience in breast diagnosis. The following are also members of the RETomo working group. Screening readers and post-recall assessment: Coriani C, MD; Pescarolo M, MD; Stefanelli G, MD; Tondelli G, MD; Beretti F, MD; Caffarri S, MD. Screening Coordinating Center: Paterlini L, MD. Radiographers Coordinator: Canovi L, Colli M, Boschini M. Scientific direction: Cavuto S; Braglia L. We thank Jacqueline Costa for editing the text. The results of this study were presented orally at a scientific session at the RSNA Annual Meeting in Chicago 2017 and at the ECR in Vienna 2018.
The study has been partially funded by the Regione Emilia-Romagna (Public Health System) and sustained by the institutional funds of the Reggio Emilia Local Health Authority (AUSL)-IRCCS.
Compliance with ethical standards
The scientific guarantor of this publication is Paolo Giorgi Rossi, PhD.
Conflict of interest
VI, AN, RV, and PP have received speakers’ fees and travel grants from GE Healthcare. CAM received financial support from GE Healthcare to allow the conclusion of the study after his retiring.
PGR, SR, CC, VM, MR, and MB disclosed no relevant relationships.
Statistics and biometry
One of the authors (Paolo Giorgi Rossi, PhD) has significant statistical expertise.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• Diagnostic or prognostic study
• Performed at one institution
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