Breast cancer detection in digital breast tomosynthesis and digital mammography-a side-by-side review of discrepant cases.

Abstract

To analyse discrepant breast cancer detection in digital breast tomosynthesis (DBT) and digital mammography (DM). From a previous detection study comparing DBT and DM, 26 discrepant cases were extracted, 19 detected by DBT only and 7 by DM only. An expert panel of three radiologists reviewed these cases and documented the level of discrepancy, lesion visibility, radiographic pattern and lesion conspicuity and assessed the reason for non-detection. Differences between groups were tested using the Wilcoxon rank sum test, the Kruskal-Wallis test and visual grading characteristics. The proportion of lesion periphery in fatty tissue was statistically significantly larger, and there were significantly more spiculated masses in DBT compared with DM in the DBT only group (p = 0.018; p = 0.015). The main reasons for missing a lesion were poor lesion visibility when using DM and interpretative error when using DBT. Lesion visualization is superior with DBT, particularly of spiculated tumours. A major reason for non-detection in DBT seems to be interpretative error, which may be due to lack of experience. Our findings suggest that DBT is better than DM in visualizing breast cancer and that non-detection when using DBT is related to interpretative error regarding clearly visible lesions.