Breast tomosynthesis and digital mammography: a comparison of diagnostic accuracy

Objective

Our aim was to compare the ability of radiologists to detect breast cancers using one-view breast tomosynthesis (BT) and two-view digital mammography (DM) in an enriched population of diseased patients and benign and/or healthy patients.

Methods

All participants gave informed consent. The BT and DM examinations were performed with about the same average glandular dose to the breast. The study population comprised patients with subtle signs of malignancy seen on DM and/or ultrasonography. Ground truth was established by pathology, needle biopsy and/or by 1-year follow-up by mammography, which retrospectively resulted in 89 diseased breasts (1 breast per patient) with 95 malignant lesions and 96 healthy or benign breasts. Two experienced radiologists, who were not participants in the study, determined the locations of the malignant lesions. Five radiologists, experienced in mammography, interpreted the cases independently in a free-response study. The data were analysed by the receiver operating characteristic (ROC) and jackknife alternative free-response ROC (JAFROC) methods, regarding both readers and cases as random effects.

Results

The diagnostic accuracy of BT was significantly better than that of DM (JAFROC: p=0.0031, ROC: p=0.0415). The average sensitivity of BT was higher than that of DM (∼90% vs ∼79%; 95% confidence interval of difference: 0.036, 0.108) while the average false-positive fraction was not significantly different (95% confidence interval of difference: −0.117, 0.010).

Conclusion

The diagnostic accuracy of BT was superior to DM in an enriched population.About 1 in 8–10 females develop breast cancer during their lifetime [1,2]. Screening mammography plays a key role in the detection of breast cancer at an early stage. Based on incidence of interval cancers it has been suggested that a radiologist reading screen-film mammograms might miss 16–30% of cancers detectable on the mammograms [3]. Mammography cancer detection varies widely: estimates of sensitivity have been reported from 68% (or as low as 48% for extremely dense breasts) to 88%, with specificities ranging from 82% to 98%. These results suggest that there is considerable room for improvement in mammography [4,5]. Digital mammography (DM) was expected to improve the performance of breast cancer detection compared with screen-film mammography (SFM). In most clinical trials the overall sensitivity has been higher for DM, but, since the specificities have also been lower, only a few studies have been statistically significant in favour of DM [5]. In a subset of females under 50 years of age in the Digital Mammographic Imaging Screening Trial study, there was a significantly improved diagnostic accuracy in DM compared with SFM [5].Because a mammogram is a two-dimensional (2D) projection of the breast onto the detector plane, overprojected healthy tissue (anatomical noise) can hamper breast cancer detectability. Anatomical noise is known to have a greater impact than quantum noise on the detection of certain breast cancers (e.g. masses) [6,7]. Two views—mediolateral oblique (MLO) and craniocaudal (CC)—can partially compensate for the overlapping anatomical noise, but this depends on the radiologist''s ability to mentally fuse the two images.Breast tomosynthesis (BT) collects 2D projection views over a limited angular range, which allows reconstruction of thin slices of the breast volume. Reduced anatomical noise from superimposed tissues is expected to improve breast cancer detection compared with DM. In CT where hundreds of projection images are acquired covering 360°, the anatomical noise can be reduced to a larger degree, but it is difficult to image the entire breast volume using CT, particularly close to the chest wall. Moreover, the average glandular dose is higher with CT, as is imaging time and the cost of the device. While there is ongoing research that may solve these issues [8-10], BT has a number of potential advantages and there are currently commercialised units.Previous studies of observer performance of BT compared with DM have shown contradictory results, varying from a statistically significant advantage for BT [11-13] to no clear advantage for BT [14-18]. Non-blinded pilot studies have been performed at our institution that suggest improved sensitivity of BT over DM [19,20].The aim of the current study was to compare the diagnostic accuracy of one-view BT with conventional two-view DM using an enriched population.     

Diagnostic accuracy of contrast-enhanced digital mammography in breast cancer detection in comparison to tomosynthesis,synthetic 2D mammography and tomosynthesis combined with ultrasound in women with dense breast

Objective:To assess the diagnostic efficacy of contrast-enhanced digital mammography (CEDM) in breast cancer detection in comparison to synthetic two-dimensional mammography (s2D MG), digital breast tomosynthesis (DBT) alone and DBT supplemented with ultrasound examination in females with dense breast with histopathology as the gold-standard.Methods:It was a prospective study, where consecutive females presenting to symptomatic breast clinic between April 2019 and June 2020 were evaluated with DBT. Females who were found to have heterogeneously dense (ACR type C) or extremely dense (ACR type D) breast composition detected on s2D MG were further evaluated with high-resolution breast ultrasound and thereafter with CEDM, but before the core biopsy or surgical excision, were included in the study. s2D MG was derived from post-processing reconstruction of DBT data set. Females with pregnancy, renal insufficiency or prior allergic reaction to iodinated contrast agent were excluded from the study. Image interpretation was done by two experienced breast radiologists and both were blinded to histological diagnosis.Results:This study included 166 breast lesions in130 patients with mean age of 45 ± 12 years (age range 24–72 years). There were 87 (52.4%) malignant and 79 (47.6%) benign lesions. The sensitivity of CEDM was 96.5%, significantly higher than synthetic 2D MG (75.6%, p < 0.0001), DBT alone (82.8%, p < 0.0001) and DBT + ultrasound (88.5%, p = 0.0057); specificity of CEDM was 81%, significantly higher than s2D MG (63.3%, p = 0.0002) and comparable to DBT alone (84.4%, p = 0.3586) and DBT + ultrasound (79.7%, p = 0.4135). In receiver operating characteristic curve analysis, the area under the curve was of 0.896 for CEDM, 0.841 for DBT + ultrasound, 0.769 for DBT alone and 0.729 for s2D MG.Conclusion:CEDM is an accurate diagnostic technique for cancer detection in dense breast. CEDM allowed a significantly higher number of breast cancer detection than the s2D MG, DBT alone and DBT supplemented with ultrasonography in females with dense breast.Advances in knowledge:CEDM is a promising novel technology with higher sensitivity and negative predictive value for breast cancer detection in females with dense breast in comparison to DBT alone or DBT supplemented with ultrasound.     

Accuracy of tumour size assessment in the preoperative staging of breast cancer: comparison of digital mammography, tomosynthesis, ultrasound and MRI

Purpose

Accurate measurement of breast tumour size is fundamental for treatment planning. We compared the accuracy of digital mammography (DM), digital breast tomosynthesis (DBT), ultrasound (US) and magnetic resonance imaging (MRI) for the preoperative evaluation of breast cancer size.

Materials and methods

We retrospectively reviewed 149 breast cancers in 110 patients who underwent DM, DBT, US and MRI between January 2010 and December 2011, before definitive surgery. The lesions were measured by two radiologists, without knowledge of the final histological examination, considered the gold standard. For each imaging modality, the maximum tumour size was measured to the nearest millimetre; the measurements were considered concordant if they were within ±5 mm. Pearson’s correlation coefficient was calculated for each imaging modality.

Results

The median pathological tumour size was 22.3 mm. MRI and DBT had a level of concordance with pathology of 70% and 66%, respectively, which was higher than that of DM (54%). DBT and MRI measurements had a better correlation with pathological tumour size (R:0.89 and R:0.92, respectively) compared to DM (R:0.83) and US (R:0.77).

Conclusions

DBT and MRI are superior to DM and US in the preoperative assessment of breast tumour size. DBT seems to improve the accuracy of DM, although MRI remains the most accurate imaging modality for breast cancer extension.     

Digital breast tomosynthesis versus mammography and breast ultrasound: a multireader performance study

Objectives

To compare the diagnostic performance of single-view breast tomosynthesis (BT) with that of dual-view mammography (MX); to assess the benefit of adding the craniocaudal (CC) mammographic view to BT, and of adding BT to MX plus breast ultrasound, considered to be the reference work-up.

Methods

One hundred and fifty-five consenting patients with unresolved mammographic and/or ultrasound findings or breast symptoms underwent conventional work-up plus mediolateral oblique-view BT of the affected breast. The final study set in 130 patients resulted in 55 malignant and 76 benign and normal cases. Seven breast radiologists rated the cases through five sequential techniques using a BIRADS-based scale: MX, MX + ultrasound, MX + ultrasound + BT, BT, BT + MX(CC). Multireader, multicase receiver operating characteristic (ROC) analysis was performed and performance of the techniques was assessed from the areas under ROC curves. The performance of BT and of BT + MX(CC) was tested versus MX; the performance of MX + ultrasound + BT tested versus MX + ultrasound.

Results

Tomosynthesis was found to be non-inferior to mammography. BT + MX(CC) did not appear to be superior to MX, and MX + ultrasound + BT not superior to MX + ultrasound.

Conclusions

Overall, none of the five techniques tested outperformed the others. Further clinical studies are needed to clarify the role of BT as a substitute for traditional work-up in the diagnostic environment.

Key Points

? Digital breast tomosynthesis is a new adjunct to mammography and breast ultrasound. ? We compared the diagnostic performance of these investigations in an experimental observer study. ? Single-view breast tomosynthesis was confirmed as non-inferior to dual-view mammography. ? None of the investigations (or combinations) tested outperformed the others. ? Further prospective studies are needed to clarify precise role of tomosynthesis for diagnostic application.     

The role of MRI in assessment of asymmetrical breast densities

This study included 86 women presented with asymmetric breast densities, seen on either routine screening or diagnostic mammogram.     

乳腺数字化断层摄影分析乳腺实质结构评估罹患乳腺癌风险:与乳腺数字化摄影比较

目的乳腺密度百分比(PD)是已被确认的罹患乳腺癌的风险因子,本研究目的是在筛查人群中评估数字化乳腺断层摄影(DBT)与数字化乳腺摄影显示的乳腺实质结构特征与PD的相关性。材料与方法本研究经专业委员会核准,受试者均签署书面知情同意书。回顾性分析2007年7月—2008年3月进行的一项经专业委员会批准的DBT筛查     

Breast tomosynthesis and digital mammography: a comparison of breast cancer visibility and BIRADS classification in a population of cancers with subtle mammographic findings

The main purpose was to compare breast cancer visibility in one-view breast tomosynthesis (BT) to cancer visibility in one- or two-view digital mammography (DM). Thirty-six patients were selected on the basis of subtle signs of breast cancer on DM. One-view BT was performed with the same compression angle as the DM image in which the finding was least/not visible. On BT, 25 projections images were acquired over an angular range of 50 degrees, with double the dose of one-view DM. Two expert breast imagers classified one- and two-view DM, and BT findings for cancer visibility and BIRADS cancer probability in a non-blinded consensus study. Forty breast cancers were found in 37 breasts. The cancers were rated more visible on BT compared to one-view and two-view DM in 22 and 11 cases, respectively, (p < 0.01 for both comparisons). Comparing one-view DM to one-view BT, 21 patients were upgraded on BIRADS classification (p < 0.01). Comparing two-view DM to one-view BT, 12 patients were upgraded on BIRADS classification (p < 0.01). The results indicate that the cancer visibility on BT is superior to DM, which suggests that BT may have a higher sensitivity for breast cancer detection.     

Mammographic density estimation: one-to-one comparison of digital mammography and digital breast tomosynthesis using fully automated software

Objective

To compare breast density on digital mammography and digital breast tomosynthesis using fully automated software.

Methods

Following institutional approval and written informed consent from all participating women, both digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) were obtained. Breast percentage density was calculated with software on DBT and FFDM.

Results

Fifty consecutive patients (mean age, 51?years; range, 35–83?years) underwent both FFDM and DBT. Using a method based on the integral curve, breast density showed higher results on FFDM (68.1?±?12.1 for FFDM and 51.9?±?6.5 for DBT). FFDM overestimated breast density in 16.2% (P?P?r?=?0.54, P?r?=?0.44, P?Conclusion Breast density appeared to be significantly underestimated on digital breast tomosynthesis.

Key Points

• Breast density is considered to be an independent risk factor for cancer
• Density can be assessed on full-field digital mammography and digital breast tomosynthesis
• Objective automated estimation of breast density eliminates subjectivity
• Automated estimation is more accurate than BI-RADS quantitative evaluation
• Breast density may be significantly underestimated on digital breast tomosynthesis

     

不同影像方法评价乳腺密度的一致性研究

目的 比较不同影像学方法评价乳腺密度的一致性.方法 搜集行DR及乳腺MR检查的患者共60例(两项检查间隔时间小于1个月).乳腺DR采集的原始图像经R2 工作站软件处理,计算机自动计算出乳房体积、乳腺实质体积及乳腺密度.乳腺X线片由2名X线影像诊断医师独立阅读,根据常用的乳腺实质分型方法(Wolfe分型、ACR分型)对58例乳腺实质进行分类.乳腺MR图像由2名影像医师通过模糊C聚类方法计算乳腺实质和脂肪的像素比例,得到乳腺密度.2周后,参与研究的其中1名影像医师重复上述工作.采用一致性检验评价各种测量方法观察者内、观察者间及不同测量方法间的一致性.结果 Wolfe分型观察者内和观察者间一致性分别为0.74、0.65;ACR分型观察者内和观察者间一致性分别为0.74、0.82;Wolfe分型与ACR分型两者间一致性为0.77;MRI得到的乳腺密度观察者内和观察者间一致性分别为0.98和0.96;MRI与X线摄影计算机自动获取的乳腺密度具有较好的一致性(r=0.81,P＜0.01).结论 乳腺DR和MR两种方法测量得到的乳腺密度具有较高的一致性,可通过R2工作站对乳腺密度进行评价.

Abstract：

Objective To Compare different methods of quantitative breast density measurement.Methods The study included sixty patients who underwent both mammography and breast MRI. The breast density was computed automatically on digital mammograms with R2 workstation. Two experienced radiologists read the mammograms and assessed the breast density with Wolfe and ACR classification respectively. Fuzzy C-means clustering algorithm (FCM) was used to assess breast density on MRI. Each assessment method was repeated after 2 weeks. Spearman and Pearson correlations of inter- and intrareader and intermodality were computed for density estimates. Results Inter- and intrareader correlation of Wolfe classification were 0. 74 and 0. 65, and they were 0. 74 and 0. 82 for ACR classification respectively.Correlation between Wolfe and ACR classification was 0. 77. High interreader correlation of 0. 98 and intrareader correlation of 0. 96 was observed with MR FCM measurement. And the correlation between digital mammograms and MRI was high in the assessment of breast density (r = 0. 81, P ＜ 0. 01). Conclusion High correlation of breast density estimates on digital mammograms and MRI FCM suggested the former could be used as a simple and accurate method.     

乳腺X线摄影与MRI对致密型乳腺内病变的诊断

目的:比较乳腺X线摄影与MRI对致密型乳腺病变的诊断价值.方法:搜集同时行乳腺X线摄影及MRI检查的致密型乳腺患者185例,所有病例均经病理证实,分别分析两种方法的影像学表现,并与病理对照.结果:185例患者中组织病理学为恶性者80例,良性105例.乳腺X线摄影诊断致密型乳腺恶性病变的敏感度、特异度、阳性预测值及阴性预...     

Comparison of the diagnostic performance of digital breast tomosynthesis and magnetic resonance imaging added to digital mammography in women with known breast cancers

Objectives

To compare the diagnostic performance of digital breast tomosynthesis (DBT) and magnetic resonance imaging (MRI) added to mammography in women with known breast cancers.

Methods

Three radiologists independently reviewed image sets of 172 patients with 184 cancers; mammography alone, DBT plus mammography and MRI plus mammography, and scored for cancer probability using the Breast Imaging Reporting and Data System (BI-RADS). Jack-knife alternative free-response receiver-operating characteristic (JAFROC), which allows diagnostic performance estimation using single lesion as a statistical unit in a cancer-only population, was used. Sensitivity and positive predictive value (PPV) were compared using the McNemar and Fisher-exact tests.

Results

The JAFROC figures of merit (FOMs) was lower in DBT plus mammography (0.937) than MRI plus mammography (0.978, P?=?0.0006) but higher than mammography alone (0.900, P?=?0 .0013). The sensitivity was lower in DBT plus mammography (88.2 %) than MRI plus mammography (97.8 %) but higher than mammography alone (78.3 %, both P?<?0 .0001). The PPV was significantly higher in DBT plus mammography (93.3 %) than MRI plus mammography (89.6 %, P?=?0 .0282).

Conclusions

DBT provided lower diagnostic performance than MRI as an adjunctive imaging to mammography. However, DBT had higher diagnostic performance than mammography and higher PPV than MRI.

Key Points

? Digital breast tomosynthesis (DBT) plus mammography was compared with MRI plus mammography. ? DBT had lower sensitivity and higher PPV than MRI. ? DBT had higher diagnostic performance than mammography.

     

Accuracy of contrast-enhanced spectral mammography compared with MRI for invasive breast cancers: Prospective study in population of predominantly underrepresented minorities

ObjectivesThis prospective study compares contrast-enhanced spectral mammography (CESM) with contrast-enhanced breast MRI in assessing the extent of newly diagnosed breast cancer in a multiethnic cohort.MethodsThis study includes 41 patients with invasive breast cancer detected by mammography or conventional ultrasound imaging from May 2017 to March 2020. CESM and MRI scans were performed prior to any treatment. Results are compared with each other and to histopathology. Detection of the malignant lesion was assessed by sensitivity, specificity, PPV, NPV. Consistency of malignant tumor size measurement was compared between modalities using Intraclass Correlation Coefficient (ICC).ResultsIn a multiethnic cohort with over 65% Hispanic and African-American women, the sensitivity of detecting malignant lesions for CESM is 93.1% (77.23%, 99.15%) and MRI is 96.55% (82.24%, 99.91%). The PPV for CESM 96.43% (81.65%, 99.91%) is better compared to MRI 82.35% (65.47%, 93.24%). CESM is as effective as MRI in evaluating index cancers and multifocal/multicentric/contralateral disease. CESM has greater specificity and PPV since MRI tends to overcall benign lesions. There is a good agreement of tumor size between CESM to surgery and MRI to surgery with ICC of 0.85 (95% CI 0.69, 0.93) and 0.87 (95% CI 0.74, 0.94), respectively. There is good agreement of malignancy detection between CESM and MRI with Kappa of 0.74 (95% CI 0.52, 0.95).ConclusionsCESM is an effective imaging modality for evaluating the extent of disease in newly diagnosed invasive breast cancers and a good alternative to MRI in a multiethnic population.     

Breast cancer detection: Comparison of digital mammography and digital breast tomosynthesis across non-dense and dense breasts

IntroductionBreast density is associated with an increase in breast cancer risk and limits early detection of the disease. This study assesses the diagnostic performance of mammogram readers in digital mammography (DM) and digital breast tomosynthesis (DBT).MethodsEleven breast readers with 1–39 years of experience reading mammograms and 0–4 years of experience reading DBT participated in the study. All readers independently interpreted 60 DM cases (40 normal/20 abnormal) and 35 DBT cases (20 normal/15 abnormal). Sensitivity, specificity, ROC AUC, and diagnostic confidence were calculated and compared between DM and DBT.ResultsDBT significantly improved diagnostic confidence in both dense breasts (p = 0.03) and non-dense breasts (p = 0.003) but not in other diagnostic performance metrics. Specificity was higher in DM for readers with >7 years' experience (p = 0.03) in reading mammography, non-radiologists (p = 0.04), readers who had completed a 3–6 months training fellowship in breast imaging (p = 0.04), and those with ≤2 years’ experience in reading DBT (p = 0.02), particularly in non-dense breasts.ConclusionDiagnostic confidence was higher in DBT when compared to DM. In contrast, other performance metrics appeared to be similar or better with DM and may be influenced by the lack of experience of the reader cohort in reading DBT.Implications for practiceThe benefits of DBT may not be entirely accrued until radiologists attain expertise in DBT interpretation. Specificity of DBT varied according to reader characteristics, and these characteristics may be useful for optimising pairing strategies in independent double reading of DBT as practiced in Australia to reduce false positive diagnostic errors.