Use of single-view digital breast tomosynthesis (DBT) and ultrasound vs. additional views and ultrasound for the assessment of screen-detected abnormalities: German multi-reader study

Abstract

Background

Data on the value of digital breast tomosynthesis (DBT) for further assessment of screen-detected lesions are still limited.

Purpose

To compare screening mammography, single-view DBT and ultrasound-information (TS) vs. screening mammography, additional views and ultrasound-information (AV) for assessment of screen-detected abnormalities.

Material and Methods

The use of wide-angle DBT for screen-detected, soft-tissue abnormalities requiring additional views was investigated: 241 cases (206 benign and 35 malignant lesions), verified by histology or two-year follow-up, were read by ten readers as TS and as AV sets, yielding 2410 diagnoses for each set. Readings were randomly sequenced.

Results

The mean interval between readings was nine weeks (random sequence). Evaluation was breast-based. Overall, in terms of area under receiver operating characteristic (AUC; varying degree of suspicion cutoff), TS and AV readings showed similar performance: for TS, AUC was 0.889 (95% confidence interval [CI] = 0.871–0.907) and for AV, AUC was 0.903 (95% CI = 0.886–0.921). TS readings had slightly higher sensitivity than AV readings (96.9% vs. 95.4%) but lower specificity (50% vs. 58.1%) and more variations between reader performance; absolute false negatives (FN) were reduced in 8/16 readers, equal in 5/16, and increased in only 3/16.

Conclusion

This study broadly confirms previous data showing equivalence of DBT to AV. However, bias against TS may have occurred since the region of interest was not indicated in the TS set as compared to its obvious identification on the AV set by the selected spot views. A key finding is that reader experience with DBT may be more important than so far reported.

Keywords

Breast neoplasms/diagnostic imaging imaging three-dimensional mammography sensitivity and specificity X-ray computed tomography AUC

Get full access to this article

View all access options for this article.

References

Duijm

Groenewoud

de Koning

et al.

Delayed diagnosis of breast cancer in women recalled for suspicious screening mammography. Eur J Cancer 2009; 45: 774–781.

Warren

Allgood

Hunnam

. East Anglian Breast Screening Programm TEABS et al. An audit of assessment procedures in women who develop breast cancer after a negative result. J Med Screen 2004; 11: 180–186.

Von Euler-Chelpin

Kuchiki

Vejborg

. Increased risk of breast cancer in women with false-positive test: the role of misclassification. Cancer Epidemiol 2014; 38: 619–622.

Brandt

Craig

Hoskins

et al.

Can DBT replace conventional diagnostic mammography views for screening recalls without calcifications? A comparison study in a simulated clinical setting. Am J Roentgenol 2013; 200: 291–298.

Cornford

Turnbull

James

et al.

Accuracy of GE DBT vs supplementary mammographic views for diagnosis of screen-detected soft-tissue breast lesions. Br J Radiol 2015; 89: 20150735–20150735.

Hakim

Chough

Ganott

et al.

DBT in the diagnostic environment: A subjective side-by-side review. Am J Roentgenol 2010; 195: W172–W176.

Morel

Iqbal

Wasan

et al.

The accuracy of DBT compared with coned compression magnification mammography in the assessment of abnormalities found on mammography. Clin Radiol 2014; 69: 1112–1126.

Noroozian

Hadjiiski

Rahnama-Moghadam

et al.

DBT is comparable to mammographic spot views for mass characterization. Radiology 2012; 262: 61–68.

Tagliafico

Astengo

Cavagnetto

et al.

One-to-one comparison between digital spot compression view and DBT. Eur Radiol 2012; 22: 539–544.

10.

Zuley

Bandos

Ganott

et al.

DBT versus supplemental diagnostic mammographic views for evaluation of noncalcified breast lesions. Radiology 2013; 266: 89–95.

11.

Whelehan

Heywang-Köbrunner

Vinnicombe

et al.

Clinical performance of Siemens DBT versus standard supplementary mammography for the assessment of screen-detected soft-tissue abnormalities – a multi-reader study. Clin Radiol 2017; 72: 95–95. e9–95.e15.

12.

Heywang-Köbrunner

Jaensch

Hacker

. Value of DBT versus additional views for the assessment of screen-detected abnormalities – a first analysis. Breast Care 2017; 12: 92–97.

13.

Lakhani SR, Ellis IO, Schnitt SJ, et al. (eds). WHO classification of tumours of the breast. Lyon: IARC, 2012.

14.

Roman

Castells

Hofvind

et al.

Risk of breast cancer after false-positive results in mammographic screening. Cancer Med 2016; 5: 1298–1306.