J Breast Cancer.  2016 Dec;19(4):438-446. 10.4048/jbc.2016.19.4.438.

Addition of Digital Breast Tomosynthesis to Full-Field Digital Mammography in the Diagnostic Setting: Additional Value and Cancer Detectability

• Seo M
• Chang JM
• Kim SA
• Kim WH
• Lim JH
• Lee SH
• Bae MS
• Koo HR
• Cho N
• Moon WK

• KMID: 2362931
• DOI: http://doi.org/10.4048/jbc.2016.19.4.438

Abstract

PURPOSE
The purpose of this study was to assess the value of adding digital breast tomosynthesis (DBT) to full-field digital mammography (FFDM) in the diagnostic workup of breast cancer and to determine which lesion variables affect cancer detectability in the combined modality.
METHODS
Between March and May 2012, paired FFDM and DBT images were obtained from 203 women as part of a diagnostic workup for breast cancer. Images from FFDM alone, DBT alone, and DBT combined with FFDM were reviewed in separate sessions by six blinded readers. Jackknife alternative free-response receiver operating characteristic (JAFROC) figure of merit (FOM), sensitivity, and specificity were compared between the modalities. Lesion characteristics affecting the cancer detection rate when using the combined modality were also analyzed.
RESULTS
Among the 203 women, 126 women had a total of 129 malignancies and 77 women had total of 77 benign lesions. The overall JAFROC FOM of the combined modality was higher than that of FFDM alone (0.827 vs. 0.775, p<0.001) and that of DBT alone was higher than that of FFDM alone (0.807 vs. 0.775, p=0.027). The overall sensitivity of the combined modality was higher than that of FFDM alone (80.0% vs. 73.2%, p<0.001) and that of DBT alone was higher than that of FFDM alone (78.3% vs. 73.2%, p=0.007). Compared to FFDM alone, the combined modality detected an additional 48 cancers. Using the combined modality, the presence of masses or microcalcifications was significantly associated with the cancer detection rate (p<0.001).
CONCLUSION
The combination of DBT with FFDM results in a higher diagnostic yield than FFDM alone. Additionally, DBT alone performs better than FFDM alone. However, even when DBT is combined with FFDM, breast cancers with no discernible masses and those lacking calcifications are difficult to detect.

Keyword

Breast; Early detection of cancer; Mammography; Three-dimensional imaging

MeSH Terms

Breast Neoplasms
Breast*
Early Detection of Cancer
Female
Humans
Imaging, Three-Dimensional
Mammography*
ROC Curve
Sensitivity and Specificity

Figure

• 

  Figure 1 Invasive ductal carcinoma in a 50-year-old woman. (A) Craniocaudal view of full-field digital mammography (FFDM) demonstrates a mass largely obscured by overlying breast tissue (arrow) which was misinterpreted as being negative by four of the six blinded readers. (B) Craniocaudal view of digital breast tomosynthesis (DBT), however, clearly demonstrates the mass (arrow) and all six readers detected the mass on combined FFDM and DBT. (C) Ultrasonography image shows a 1.5-cm irregular, hypoechoic mass with indistinct margins (arrows).

• 

  Figure 2 Invasive ductal carcinoma in a 47-year-old woman. (A) Craniocaudal view of full-field digital mammography shows a heterogeneously dense breast tissue which was interpreted as negative by six blinded readers. (B) Craniocaudal view of digital breast tomosynthesis also shows heterogeneously dense breast tissue at the same location. (C) Ultrasonography image shows a 1.1-cm irregular, hypoechoic mass with indistinct margins (arrows).

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