Abstract
Purpose
To compare the efficacy of use of digital breast tomosynthesis (DBT) with standard digital mammography (DM) workup views in the breast cancer assessment clinic.
Materials and methods
The Tomosynthesis Assessment Clinic trial (TACT), conducted between 16 October 2014 and 19 April 2016, is an ethics-approved, monocenter, multireader, multicase split-plot reading study. After written informed consent was obtained, 144 females (age > 40 years) who were recalled to the assessment clinic were recruited into TACT. These cases (48 cancers) were randomly allocated for blinded review of (1) DM workup and (2) DBT, both in conjunction with previous DM from the screening examination. Fifteen radiologists of varying experience levels in the Australia BreastScreen Program were included in this study, wherein each radiologist read 48 cases (16 cancers) in 3 non-overlapping blocks. Diagnostic accuracy was measured by means of sensitivity, specificity, and positive (PPV) and negative predictive values (NPV). The receiver-operating characteristic area under the curve (AUC) was calculated to determine radiologists’ performances.
Results
Use of DBT (AUC = 0.927) led to improved performance of the radiologists (z = 2.62, p = 0.008) compared with mammography workup (AUC = 0.872). Similarly, the sensitivity, specificity, PPV, and NPV of DBT (0.93, 0.75, 0.64, 0.96) were higher than those of the workup (0.90, 0.56, 0.49, 0.92). Most radiologists (80%) performed better with DBT than standard workup. Cancerous lesions on DBT appeared more severe (U = 33,172, p = 0.02) and conspicuous (U = 24,207, p = 0.02). There was a significant reduction in the need for additional views (χ2 = 17.63, p < 0.001) and recommendations for ultrasound (χ2 = 8.56, p = 0.003) with DBT.
Conclusions
DBT has the potential to increase diagnostic accuracy and simplify the assessment process in the breast cancer assessment clinic.
Key Points
• Use of DBT in the assessment clinic results in increased diagnostic accuracy.
• Use of DBT in the assessment clinic improves performance of radiologists and also increases the confidence in their decisions.
• DBT may reduce the need for additional views, ultrasound imaging, and biopsy.
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Abbreviations
- AUC:
-
Area under the curve
- CC:
-
Craniocaudal
- DBT:
-
Digital breast tomosynthesis
- DM:
-
Digital mammography
- DMW:
-
Digital mammography workup views
- FDA:
-
US Food and Drug Administration
- FN:
-
False negative
- FP:
-
False positive
- ML:
-
Mediolateral
- MLO:
-
Mediolateral oblique
- MRMC:
-
Multi-reader multi-case
- NPV:
-
Negative predictive values
- NSW:
-
New South Wales
- p :
-
p value
- PPV:
-
Positive predictive values
- SVM:
-
Spot-view mammogram
- TACT:
-
Tomosynthesis Assessment Clinic Trial
- TN:
-
True negative
- TP:
-
True positive
- U:
-
Test statistics for the Mann-Whitney U test
- z:
-
Test statistics for the z-test a.k.a. Wald test
- χ 2 :
-
Test statistics for the chi-square test
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Acknowledgements
We would like to thank Northern Sydney Local Health District, BreastScreen Northern Sydney and Central Coast, New South Wales, Australia, and the Cancer Institute New South Wales, Australia, for their support of this study. We also thank Amanda Chapman, Andrew Varnava, Carolin Skipka, Craig Cetinich, Garry Potts, Monica Connolly, and Sarah McGill for their help in this study.
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The authors state that this work has not received any funding.
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The scientific guarantor of this publication is Claudia Mello-Thoms.
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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
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One of the authors has significant statistical expertise.
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Written informed consent was obtained from all subjects (patients) in this study.
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Institutional Review Board approval was obtained.
Methodology
• retrospective
• case-control study
• performed at one institution
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Suneeta Mall and Jennie Noakes Joint first co-authors
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Mall, S., Noakes, J., Kossoff, M. et al. Can digital breast tomosynthesis perform better than standard digital mammography work-up in breast cancer assessment clinic?. Eur Radiol 28, 5182–5194 (2018). https://doi.org/10.1007/s00330-018-5473-4
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DOI: https://doi.org/10.1007/s00330-018-5473-4