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Diagnostic performance of tomosynthesis and breast ultrasonography in women with dense breasts: a prospective comparison study

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Breast Cancer Research and Treatment Aims and scope Submit manuscript

An Erratum to this article was published on 24 February 2017

Abstract

Purpose

To compare the diagnostic performances of tomosynthesis and ultrasonography as adjunctives to digital mammography in women with dense breasts.

Methods

A total of 778 women with dense breasts underwent digital mammography with tomosynthesis and ultrasonography for screening and diagnostic purposes. The findings of tomosynthesis and ultrasonography were evaluated independently. The primary endpoint was overall diagnostic accuracy determined by area under the receiver operating characteristic curve (AUC). Secondary endpoints included sensitivity, specificity, and predictive values.

Results

Of the 778 participants, 698 women (140 breast cancers) were included in the analysis. Based on the AUC findings, the non-inferiority of tomosynthesis to ultrasonography was established in the overall group as well as in all subgroups except for that comprising women with extremely dense breast composition. There were no significant differences in AUC between tomosynthesis and ultrasonography among asymptomatic participants and participants who underwent imaging for screening (0.912 vs. 0.934 [P = 0.403] and 0.987 vs. 0.950 [P = 0.270], respectively). Tomosynthesis exhibited lower sensitivity (91.4 vs. 96.4%; P = 0.039), and higher specificity (83.9 vs. 70.4%; P < 0.001) and positive predictive value (58.7 vs. 45.0%; P < 0.001) than ultrasonography.

Conclusions

Tomosynthesis exhibits comparable performance to ultrasonography as an adjunct to mammography for diagnosis of breast cancer, except among women with extremely dense breasts.

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Abbreviations

2D:

Two-dimensional

AUC:

Area under the ROC curve

BI-RADS:

Breast imaging reporting and data system

CI:

Confidence interval

DCIS:

Ductal carcinoma in situ

IDC:

Invasive ductal carcinomas

NPV:

Negative predictive value

PPV:

Positive predictive value

ROC:

Receiver operating characteristic

SD:

Standard deviation

References

  1. Kolb TM, Lichy J, Newhouse JH (2002) Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology 225(1):165–175. doi:10.1148/radiol.2251011667

    Article  PubMed  Google Scholar 

  2. Price ER, Hargreaves J, Lipson JA, Sickles EA, Brenner RJ, Lindfors KK, Joe BN, Leung JW, Feig SA, Bassett LW, Ojeda-Fournier H, Daniel BL, Kurian AW, Love E, Ryan L, Walgenbach DD, Ikeda DM (2013) The California breast density information group: a collaborative response to the issues of breast density, breast cancer risk, and breast density notification legislation. Radiology 269(3):887–892. doi:10.1148/radiol.13131217

    Article  PubMed  Google Scholar 

  3. Rhodes DJ, Radecki Breitkopf C, Ziegenfuss JY, Jenkins SM, Vachon CM (2015) Awareness of breast density and its impact on breast cancer detection and risk. J Clin Oncol 33(10):1143–1150. doi:10.1200/JCO.2014.57.0325

    Article  PubMed  PubMed Central  Google Scholar 

  4. Berg WA, Blume JD, Cormack JB, Mendelson EB, Lehrer D, Bohm-Velez M, Pisano ED, Jong RA, Evans WP, Morton MJ, Mahoney MC, Larsen LH, Barr RG, Farria DM, Marques HS, Boparai K, Investigators A (2008) Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA 299(18):2151–2163. doi:10.1001/jama.299.18.2151

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Berg WA, Zhang Z, Lehrer D, Jong RA, Pisano ED, Barr RG, Bohm-Velez M, Mahoney MC, Evans WP 3rd, Larsen LH, Morton MJ, Mendelson EB, Farria DM, Cormack JB, Marques HS, Adams A, Yeh NM, Gabrielli G, Investigators A (2012) Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA 307(13):1394–1404. doi:10.1001/jama.2012.388

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Ohuchi N, Suzuki A, Sobue T, Kawai M, Yamamoto S, Zheng YF, Shiono YN, Saito H, Kuriyama S, Tohno E, Endo T, Fukao A, Tsuji I, Yamaguchi T, Ohashi Y, Fukuda M, Ishida T, groups JSi (2015) Sensitivity and specificity of mammography and adjunctive ultrasonography to screen for breast cancer in the Japan Strategic Anti-cancer Randomized Trial (J-START): a randomised controlled trial. Lancet. doi:10.1016/S0140-6736(15)00774-6

    PubMed  Google Scholar 

  7. Sprague BL, Lehman CD, Tosteson AN (2015) Supplemental ultrasonography screening for women with dense breasts. Ann Intern Med 162(11):802–803. doi:10.7326/L15-5061-4

    Article  PubMed  Google Scholar 

  8. Berg WA, Blume JD, Cormack JB, Mendelson EB (2006) Operator dependence of physician-performed whole-breast US: lesion detection and characterization. Radiology 241(2):355–365. doi:10.1148/radiol.2412051710

    Article  PubMed  Google Scholar 

  9. Kopans DB (2014) Digital breast tomosynthesis from concept to clinical care. AJR Am J Roentgenol 202(2):299–308. doi:10.2214/AJR.13.11520

    Article  PubMed  Google Scholar 

  10. Ciatto S, Houssami N, Bernardi D, Caumo F, Pellegrini M, Brunelli S, Tuttobene P, Bricolo P, Fanto C, Valentini M, Montemezzi S, Macaskill P (2013) Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study. Lancet Oncol 14(7):583–589. doi:10.1016/S1470-2045(13)70134-7

    Article  PubMed  Google Scholar 

  11. Haas BM, Kalra V, Geisel J, Raghu M, Durand M, Philpotts LE (2013) Comparison of tomosynthesis plus digital mammography and digital mammography alone for breast cancer screening. Radiology 269(3):694–700. doi:10.1148/radiol.13130307

    Article  PubMed  Google Scholar 

  12. Rafferty EA, Park JM, Philpotts LE, Poplack SP, Sumkin JH, Halpern EF, Niklason LT (2013) Assessing radiologist performance using combined digital mammography and breast tomosynthesis compared with digital mammography alone: results of a multicenter, multireader trial. Radiology 266(1):104–113. doi:10.1148/radiol.12120674

    Article  PubMed  Google Scholar 

  13. McDonald ES, Oustimov A, Weinstein SP, Synnestvedt MB, Schnall M, Conant EF (2016) Effectiveness of digital breast tomosynthesis compared with digital mammography: outcomes analysis from 3 years of breast cancer screening. JAMA Oncol. doi:10.1001/jamaoncol.2015.5536

    PubMed Central  Google Scholar 

  14. Feng SS, Sechopoulos I (2012) Clinical digital breast tomosynthesis system: dosimetric characterization. Radiology 263(1):35–42. doi:10.1148/radiol.11111789

    Article  PubMed  PubMed Central  Google Scholar 

  15. D’Orsi CJSE, Mendelson EB et al (2013) ACR BI-RADS Atlas, Breast Imaging Reporting and Data System. American College of Radiology, Reston

    Google Scholar 

  16. Kosinski AS (2013) A weighted generalized score statistic for comparison of predictive values of diagnostic tests. Stat Med 32(6):964–977. doi:10.1002/sim.5587

    Article  PubMed  Google Scholar 

  17. Elizalde A, Pina L, Etxano J, Slon P, Zalazar R, Caballeros M (2016) Additional US or DBT after digital mammography: which one is the best combination? Acta Radiol 57(1):13–18. doi:10.1177/0284185114563641

    Article  PubMed  Google Scholar 

  18. Gilbert FJ, Tucker L, Gillan MG, Willsher P, Cooke J, Duncan KA, Michell MJ, Dobson HM, Lim YY, Purushothaman H, Strudley C, Astley SM, Morrish O, Young KC, Duffy SW (2015) The TOMMY trial: a comparison of TOMosynthesis with digital MammographY in the UK NHS Breast Screening Programme–a multicentre retrospective reading study comparing the diagnostic performance of digital breast tomosynthesis and digital mammography with digital mammography alone. Health Technol Assess 19(4):1–136. doi:10.3310/hta19040

    Article  PubMed  PubMed Central  Google Scholar 

  19. Emaus MJ, Bakker MF, Peeters PH, Loo CE, Mann RM, de Jong MD, Bisschops RH, Veltman J, Duvivier KM, Lobbes MB, Pijnappel RM, Karssemeijer N, de Koning HJ, van den Bosch MA, Monninkhof EM, Mali WP, Veldhuis WB, van Gils CH (2015) MR imaging as an additional screening modality for the detection of breast cancer in women aged 50-75 years with extremely dense breasts: the DENSE trial study design. Radiology 277(2):527–537. doi:10.1148/radiol.2015141827

    Article  PubMed  Google Scholar 

  20. Sprague BL, Stout NK, Schechter C, van Ravesteyn NT, Cevik M, Alagoz O, Lee CI, van den Broek JJ, Miglioretti DL, Mandelblatt JS, de Koning HJ, Kerlikowske K, Lehman CD, Tosteson AN (2015) Benefits, harms, and cost-effectiveness of supplemental ultrasonography screening for women with dense breasts. Ann Intern Med 162(3):157–166. doi:10.7326/M14-0692

    Article  PubMed  PubMed Central  Google Scholar 

  21. Nothacker M, Duda V, Hahn M, Warm M, Degenhardt F, Madjar H, Weinbrenner S, Albert US (2009) Early detection of breast cancer: benefits and risks of supplemental breast ultrasound in asymptomatic women with mammographically dense breast tissue. A systematic review. BMC Cancer 9:335. doi:10.1186/1471-2407-9-335

    Article  PubMed  PubMed Central  Google Scholar 

  22. Buchberger W, DeKoekkoek-Doll P, Springer P, Obrist P, Dunser M (1999) Incidental findings on sonography of the breast: clinical significance and diagnostic workup. AJR Am J Roentgenol 173(4):921–927. doi:10.2214/ajr.173.4.10511149

    Article  CAS  PubMed  Google Scholar 

  23. Mariscotti G, Houssami N, Durando M, Bergamasco L, Campanino PP, Ruggieri C, Regini E, Luparia A, Bussone R, Sapino A, Fonio P, Gandini G (2014) Accuracy of mammography, digital breast tomosynthesis, ultrasound and MR imaging in preoperative assessment of breast cancer. Anticancer Res 34(3):1219–1225

    PubMed  Google Scholar 

  24. Tagliafico AS, Calabrese M, Mariscotti G, Durando M, Tosto S, Monetti F, Airaldi S, Bignotti B, Nori J, Bagni A, Signori A, Sormani MP, Houssami N (2016) Adjunct screening with tomosynthesis or ultrasound in women with mammography-negative dense breasts: interim report of a prospective comparative trial. J Clin Oncol. doi:10.1200/JCO.2015.63.4147

    PubMed  Google Scholar 

Download references

Funding

This research was supported by a grant (number 05-2014-0040) from the Seoul National University Hospital Research Fund, and the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (Grant Number: HI14C1234).

Author information

Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea

    Won Hwa Kim, Jung Min Chang, Su Hyun Lee, Nariya Cho, Min Sun Bae, Sung Ui Shin & Woo Kyung Moon

  2. Department of Radiology, Kyungpook National University Medical Center, Daegu, South Korea

    Won Hwa Kim

  3. Division of Clinical Epidemiology, Medical Research Collaborating Center, Biomedical Research Institution, Seoul National University Hospital, Seoul, South Korea

    Joongyub Lee

  4. Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea

    A Jung Chu

  5. Department of Radiology, Kyung Hee University Hospital, Seoul, South Korea

    Mirinae Seo

  6. Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

    Hye Mi Gweon

  7. Department of Radiology, Hanyang University College of Medicine, Seoul, South Korea

    Hye Ryoung Koo

  8. Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea

    Sung Eun Song

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  1. Won Hwa Kim
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Correspondence to Jung Min Chang.

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Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s10549-017-4172-1.

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Kim, W.H., Chang, J.M., Lee, J. et al. Diagnostic performance of tomosynthesis and breast ultrasonography in women with dense breasts: a prospective comparison study. Breast Cancer Res Treat 162, 85–94 (2017). https://doi.org/10.1007/s10549-017-4105-z

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  • DOI: https://doi.org/10.1007/s10549-017-4105-z

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