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

Manisha Bahl; Sarah Mercaldo; Charmi A Vijapura; Anne Marie McCarthy; Constance D Lehman

doi:10.1007/s00330-018-5596-7

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

Eur Radiol. 2019 Feb;29(2):477-484. doi: 10.1007/s00330-018-5596-7. Epub 2018 Jul 2.

Authors

Manisha Bahl¹, Sarah Mercaldo², Charmi A Vijapura³, Anne Marie McCarthy⁴, Constance D Lehman³

Affiliations

¹ Division of Breast Imaging/Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, WAC 240, Boston, MA, USA. [email protected].
² Department of Radiology, Massachusetts General Hospital, 101 Merrimac Street, STE 1010, Boston, MA, USA.
³ Division of Breast Imaging/Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, WAC 240, Boston, MA, USA.
⁴ Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, Boston, MA, USA.

PMID: 29967957
DOI: 10.1007/s00330-018-5596-7

Abstract

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

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: Benchmark; Breast cancer; Breast carcinoma in situ; Digital breast tomosynthesis; Digital mammography.

Publication types

Comparative Study

MeSH terms

Adult
Aged
Benchmarking
Biopsy, Large-Core Needle
Breast Neoplasms / diagnostic imaging*
Breast Neoplasms / pathology
Early Detection of Cancer / methods
Female
Humans
Imaging, Three-Dimensional / methods
Mammography / methods*
Middle Aged
Radiographic Image Interpretation, Computer-Assisted / methods
Retrospective Studies
Sensitivity and Specificity