European Radiology

, Volume 27, Issue 12, pp 5179–5184 | Cite as

Accuracy and reading time for six strategies using digital breast tomosynthesis in women with mammographically negative dense breasts

  • Alberto Stefano Tagliafico
  • Massimo Calabrese
  • Bianca Bignotti
  • Alessio Signori
  • Erica Fisci
  • Federica Rossi
  • Francesca Valdora
  • Nehmat Houssami



To compare six strategies using digital breast tomosynthesis in women with mammographically negative dense breasts.

Materials and methods

This is a substudy of the ‘ASTOUND’ trial. 163 women who underwent tomosynthesis with synthetically reconstructed projection images (S-2D) inclusive of 13 (7.9%) cases diagnosed with breast cancer at histopathology after surgery were evaluated. Accuracy measures and screen-reading time of six reading strategies were assessed: (A) Single reading of S-2D alone, (B) single reading of tomosynthesis alone, (C) single reading of joint interpretation of tomosynthesis + S-2D, (D) double-reading of S-2D alone, (E) double reading of tomosynthesis alone, (F) double reading of joint interpretation of tomosynthesis + S-2D.


The median age of the patients was 53 years (range, 36–88 years). The highest global accuracy was obtained with double reading of tomosynthesis + S2D (F) with an AUC of 0.979 (p<0.001) and a mean reading time of 154 s versus 34 s for the fastest strategy (single reading of S-2D alone). The AUCs for the other five strategies did not differ from each other.


Double reading of tomosynthesis+ S2D had the best accuracy of six screen-reading strategies although it had the longest reading time.

Key Points

Tomosynthesis acquisitions are progressively implemented with reconstructed synthesized 2D images

Double reading using S-2D plus tomosynthesis had the highest global accuracy (p<0.001).

Double reading of S-2D plus tomosynthesis increased reading time.


Accuracy Reading time Digital Breast Tomosynthesis Dense breasts Breast density 


Compliance with ethical standards


The scientific guarantor of this publication is Alberto Tagliafico, MD.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

Alberto Stefano Tagliafico: Honoraria: Esaote-Philips. Patents, Royalties, Other Intellectual

Property: Springer. Travel, Accommodations, Expenses: Hologic, Technologic.

Massimo Calabrese: Travel, Accommodations, Expenses: Hologic, Technologic

The other Authors have nothing to disclose.


The authors state that this work was partially funded through the following sources: A.S.T. receives research support from Associazione Italiana per la Ricerca sul Cancro (IG n.15697) and University of Genoa (PRA 2013). N.H. receives research support from a National Breast Cancer Foundation Australia Breast Cancer Research Leadership Fellowship. F.V. receives research support from Associazione Italiana per la Ricerca sul Cancro (IG n.15697)

Statistics and biometry

The statistical analysis was done entirely by four authors with specific expertise in medical statistics: Prof. Alberto Stefano Tagliafico, Dr. Bianca Bignotti, Prof. Nehmat Houssami and by a professional biostatistician, Dr. Alessio Signori.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board: the study received institutional review board approval (514REG2014).




-Performed at one institution


  1. 1.
    Berg WA (2016) Current Status of Supplemental Screening in Dense Breasts. J Clin Oncol. doi: 10.1200/JCO.2015.65.8674 Google Scholar
  2. 2.
    Tagliafico A, Houssami N (2015) Digital breast tomosynthesis might not be the optimal modality for detecting microcalcification. Radiology 275:618–619CrossRefPubMedGoogle Scholar
  3. 3.
    Tagliafico A, Mariscotti G, Durando M et al (2015) Characterisation of microcalcification clusters on 2D digital mammography (FFDM) and digital breast tomosynthesis (tomosynthesis): does tomosynthesis underestimate microcalcification clusters? Results of a multicentre study. Eur Radiol 25:9–14CrossRefPubMedGoogle Scholar
  4. 4.
    Tagliafico AS, Calabrese M, Mariscotti G et al (2016) Adjunct Screening With Tomosynthesis or Ultrasound in Women With Mammography-Negative Dense Breasts: Interim Report of a Prospective Comparative Trial. J Clin Oncol 2016 Mar 9Google Scholar
  5. 5.
    Bernardi D, Ciatto S, Pellegrini M et al (2012) Application of breast tomosynthesis in screening: incremental effect on mammography acquisition and reading time. Br J Radiol 85:e1174–8CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Skaane P, Bandos AI, Eben EB et al (2014) Two-view digital breast tomosynthesis screening with synthetically reconstructed projection images: comparison with digital breast tomosynthesis with full-field digital mammographic images. Radiology 271:655–663CrossRefPubMedGoogle Scholar
  7. 7.
    Choi J, Han B, Ko E et al (2016) Comparison with Two-Dimensional Synthetic Mammography Reconstructed from Digital Breast Tomosynthesis and Full Field Digital Mammography for the Detection of T1 Breast Cancer. Eur Radiol 26:2538–2546CrossRefPubMedGoogle Scholar
  8. 8.
    Bernardi D, Macaskill P, Pellegrini M et al (2016) Breast cancer screening with tomosynthesis (3D mammography) with acquired or synthetic 2D mammography compared with 2D mammography alone (STORM-2): a population-based prospective study. Lancet Oncol 17:1105–1113CrossRefPubMedGoogle Scholar
  9. 9.
    Gennaro G, Toledano A, di Maggio C et al (2010) Digital breast tomosynthesis versus digital mammography: a clinical performance study. Eur Radiol 20:1545–1553CrossRefPubMedGoogle Scholar
  10. 10.
    Tagliafico A, Astengo D, Cavagnetto F et al (2012) One-to-one comparison between digital spot compression view and digital breast tomosynthesis. Eur Radiol 22:539–544CrossRefPubMedGoogle Scholar
  11. 11.
    Perry N, Broeders M, de Wolf C, Törnberg S, Holland R, von Karsa L (2006) European guidelines for quality assurance in breast cancer screening and diagnosis. Health & Consum Protec Directorate-General, European Commun 2006:232e5Google Scholar
  12. 12.
    Skaane P, Bandos AI, Gullien R et al (2013) Prospective trial comparing full-field digital mammography (FFDM) versus combined FFDM and tomosynthesis in a population-based screening programme using independent double reading with arbitration. Eur Radiol 23:2061–2071CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Lang K, Andersson I, Rosso A, Tingberg A, Timberg P, Zackrisson S (2016) Performance of one-view breast tomosynthesis as a stand-alone breast cancer screening modality: results from the Malmo Breast Tomosynthesis Screening Trial, a population-based study. Eur Radiol 26:184–190CrossRefPubMedGoogle Scholar
  14. 14.
    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 269:694–700CrossRefPubMedGoogle Scholar
  15. 15.
    Conant EF, Beaber EF, Sprague BL et al (2016) Breast cancer screening using tomosynthesis in combination with digital mammography compared to digital mammography alone: a cohort study within the PROSPR consortium. Breast Cancer Res Treat 156:109–116CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Friedewald SM, Rafferty EA, Rose SL et al (2014) Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA 311:2499–2507CrossRefPubMedGoogle Scholar
  17. 17.
    McCarthy AM, Kontos D, Synnestvedt M et al (2014) Screening outcomes following implementation of digital breast tomosynthesis in a general- population screening program. J. Natl. Cancer Inst 106(11). doi:  10.1093/jnci/dju316
  18. 18.
    Greenberg JS, Javitt MC, Katzen J, Michael S, Holland AE (2014) Clinical performance metrics of 3D digital breast tomosynthesis compared with 2D digital mammography for breast cancer screening in community practice. AJR Am J Roentgenol 203:687–693CrossRefPubMedGoogle Scholar
  19. 19.
    Durand MA, Haas BM, Yao X et al (2015) Early clinical experience with digital breast tomosynthesis for screening mammography. Radiology 274:85–92CrossRefPubMedGoogle Scholar
  20. 20.
    Lauby-Secretan B, Scoccianti C, Loomis D et al (2015) Breast-cancer screening viewpoint of the IARC working group. New Engl J Med 372:2353–2358CrossRefPubMedGoogle Scholar
  21. 21.
    Siu AL, U.S. Preventive Services Task Force (2016) Screening for Breast cancer: U.S. preventive services task force recommendation statement. Ann Intern Med 164:279–296CrossRefPubMedGoogle Scholar
  22. 22.
    Barratt A (2015) Overdiagnosis in mammography screening: a 45 year journey from shadowy idea to acknowledged reality. BMJ 350:h867CrossRefPubMedGoogle Scholar
  23. 23.
    Houssami N, Miglioretti DL (2016) Digital Breast tomosynthesis: a brave new world of mammography screening. JAMA Oncol 2:725–727CrossRefPubMedGoogle Scholar
  24. 24.
    Houssami N, Bernardi D, Pellegrini M et al (2017) Breast cancer detection using single reading of breast tomosynthesis (3D-mammography) compared to double reading of 2D-mammography: Evidence from a population-based trial. Cancer Epidemiol 47:94–99 [Epub ahead of print]CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Alberto Stefano Tagliafico
    • 1
    • 2
  • Massimo Calabrese
    • 3
  • Bianca Bignotti
    • 1
  • Alessio Signori
    • 1
  • Erica Fisci
    • 1
  • Federica Rossi
    • 1
  • Francesca Valdora
    • 4
  • Nehmat Houssami
    • 5
  1. 1.Department of Health Sciences (DISSAL), Radiology SectionUniversity of Genoa and Emergency Radiology, IRCCS AOU San Martino-ISTGenoaItaly
  2. 2.Emergency RadiologyPoliclinico San MartinoGenoaItaly
  3. 3.Breast RadiologyPoliclinico San MartinoGenoaItaly
  4. 4.Department of Experimental Medicine (DIMES)University of GenoaGenoaItaly
  5. 5.Sydney School of Public Health, Sydney Medical SchoolUniversity of SydneySydneyAustralia

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