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Comparison of performance metrics with digital 2D versus tomosynthesis mammography in the diagnostic setting



To compare performance metrics between digital 2D mammography (DM) and digital breast tomosynthesis (DBT) in the diagnostic setting.


Consecutive diagnostic examinations from August 2008 to February 2011 (DM group) and from January 2013 to July 2015 (DM/DBT group) were reviewed. Core biopsy and surgical pathology results within 365 days after the mammogram were collected. Performance metrics, including cancer detection rate (CDR), abnormal interpretation rate (AIR), positive predictive value (PPV) 2, PPV3, sensitivity, and specificity were calculated. Multivariable logistic regression models were fit to compare performance metrics in the DM and DM/DBT groups while adjusting for clinical covariates.


A total of 22,883 mammograms were performed before DBT integration (DM group), and 22,824 mammograms were performed after complete DBT integration (DM/DBT group). After adjusting for multiple variables, the CDR was similar in both groups (38.2 per 1,000 examinations in the DM/DBT group versus 31.3 per 1,000 examinations in the DM group, p = 0.14); however, a higher proportion of cancers were invasive rather than in situ in the DM/DBT group [83.7% (731/873) versus 72.3% (518/716), p < 0.01]. The AIR was lower in the DM/DBT group (p < 0.01), and PPV2, PPV3, and specificity were higher in the DM/DBT group (all p = 0.01 or p < 0.01).


Complete integration of DBT into the diagnostic setting is associated with improved diagnostic performance. Increased utilization of DBT may thus result in better patient outcomes and lead to a shift in the benchmarks that have been established for DM.

Key Points

• Integration of tomosynthesis into the diagnostic setting is associated with improved performance.

• A higher proportion of cancers are invasive rather than in situ with digital breast tomosynthesis.

• Increased utilization of tomosynthesis may lead to a shift in established benchmarks.

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Fig. 1



Abnormal interpretation rate


Breast Cancer Surveillance Consortium


Breast Imaging Reporting and Data System


Cancer detection rate


Digital breast tomosynthesis


Digital 2D mammography


Positive predictive value


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This study was presented as an electronic poster at the 2017 Society of Breast Imaging (SBI)/American College of Radiology (ACR) Breast Imaging Symposium.


The authors state that this work has not received any funding.

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Correspondence to Manisha Bahl.

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The scientific guarantor of this publication is Manisha Bahl, MD, MPH.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Constance D. Lehman, MD, PhD, has a research grant from GE Healthcare and serves on an advisory board for GE Healthcare. The authors of this manuscript declare no other relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Sarah Mercaldo, PhD) has significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• observational

• performed at one institution

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Bahl, M., Mercaldo, S., Vijapura, C.A. et al. Comparison of performance metrics with digital 2D versus tomosynthesis mammography in the diagnostic setting. Eur Radiol 29, 477–484 (2019).

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