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Combination of one-view digital breast tomosynthesis with one-view digital mammography versus standard two-view digital mammography: per lesion analysis

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Abstract

Objective

To evaluate the clinical value of combining one-view mammography (cranio-caudal, CC) with the complementary view tomosynthesis (mediolateral-oblique, MLO) in comparison to standard two-view mammography (MX) in terms of both lesion detection and characterization.

Methods

A free-response receiver operating characteristic (FROC) experiment was conducted independently by six breast radiologists, obtaining data from 463 breasts of 250 patients. Differences in mean lesion detection fraction (LDF) and mean lesion characterization fraction (LCF) were analysed by analysis of variance (ANOVA) to compare clinical performance of the combination of techniques to standard two-view digital mammography.

Results

The 463 cases (breasts) reviewed included 258 with one to three lesions each, and 205 with no lesions. The 258 cases with lesions included 77 cancers in 68 breasts and 271 benign lesions to give a total of 348 proven lesions. The combination, DBT(MLO)+MX(CC), was superior to MX (CC+MLO) in both lesion detection (LDF) and lesion characterization (LCF) overall and for benign lesions. DBT(MLO)+MX(CC) was non-inferior to two-view MX for malignant lesions.

Conclusions

This study shows that readers’ capabilities in detecting and characterizing breast lesions are improved by combining single-view digital breast tomosynthesis and single-view mammography compared to two-view digital mammography.

Key Points

• Digital breast tomosynthesis is becoming adopted as an adjunct to mammography (MX)

DBT (MLO) +MX (CC) is superior to MX (CC+MLO) in lesion detection (overall and benign lesions)

DBT (MLO) +MX (CC) is non-inferior to MX (CC+MLO) in cancer detection

DBT (MLO) +MX (CC) is superior to MX (CC+MLO) in lesion characterization (overall and benign lesions)

DBT (MLO) +MX (CC) is non-inferior to MX (CC+MLO) in characterization of malignant lesions

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Abbreviations

ANOVA:

analysis of variance

CC:

cranio-caudal

DBT:

digital breast tomosynthesis

DBT(MLO)+MX(CC) :

combination of one-view (MLO) tomosynthesis and one-view (CC) mammography

FROC:

free-response receiver operating characteristics

LCF:

lesion characterization fraction

LDF:

lesion detection fraction

MLO:

medio-lateral oblique

MX:

standard mammography

MX(CC+MLO) :

standard mammography in two views

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Acknowledgements

The authors would like to thank Luc Katz, Aurora Talaverano, Francesca Braga, Henri Souchay, Razvan Iordache, Sylvain Bernard and Laura Hernandez from GE Healthcare for scientific discussions and technical support. They are also grateful to Andrea Azzalini for his help in preparation of manuscript illustrations.

R Edward Hendrick and Alicia Toledano are consultants to GE Healthcare.

This paper uses the same diagnostic subjects as another paper previously published in European Radiology, but applies per-lesion analysis rather than the more standard per-case analysis. Perlesion analysis, less popular than conventional ROC analysis, allows for the possibility of multiple lesions per case, and considers both lesion detection and lesion characterization. The per-lesion approach increases the statistical power of the analysis and allows us to better determine the potential diagnostic role of DBT in clinical application.

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Correspondence to Gisella Gennaro.

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Gennaro, G., Hendrick, R.E., Toledano, A. et al. Combination of one-view digital breast tomosynthesis with one-view digital mammography versus standard two-view digital mammography: per lesion analysis. Eur Radiol 23, 2087–2094 (2013). https://doi.org/10.1007/s00330-013-2831-0

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  • DOI: https://doi.org/10.1007/s00330-013-2831-0

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