Comparison of two-view versus single-view digital breast tomosynthesis and 2D-mammography in breast cancer surveillance imaging.

Andria Hadjipanteli,Petros Polyviou,Anne Papoutsou,Demetris Moniatis,Natasa Kotziamani,Marios Genagritis,Anastasia Constantinidou,Ilias Kyriakopoulos,Gayle E Woloschak

doi:10.1371/journal.pone.0256514

Abstract

PurposeLimited work has been performed for the implementation of digital breast tomosynthesis (DBT) in breast cancer surveillance imaging. The aim of this study was to investigate the differences between two different DBT implementations in breast cancer surveillance imaging, for patients with a personal history of breast cancer.MethodThe DBT implementations investigated were: (1) 2-view 2D digital mammography and 2-view DBT (2vDM&2vDBT) (2) 1-view (cranial-caudal) DM and 1-view (mediolateral-oblique) DBT (1vDM&1vDBT). Clinical performance of these two implementations was assessed retrospectively using observer studies with 118 sets of real patient images, from a single imaging centre, and six observers. Sensitivity, specificity and area under the curve (AUC) using the Jack-knife alternative free-response receiver operating characteristics (JAFROC) analysis were evaluated.ResultsResults suggest that the two DBT implementations are not significantly different in terms of sensitivity, specificity and AUC. When looking at the two main different lesion types, non-calcifications and calcifications, and two different density levels, no difference in the performance of the two DBT implementations was found.ConclusionsSince 1vDM&1vDBT exposes the patient to half the dose of 2vDM&2vDBT, it might be worth considering 1vDM&1vDBT in breast cancer surveillance imaging. However, larger studies are required to conclude on this matter.

Highlights

Digital breast tomosynthesis (DBT) has been under consideration for its use in breast screening alone or in combination with 2D digital mammography (DM) and/or synthetic mammography (SM) for several years
Results suggest that the two DBT implementations are not significantly different in terms of sensitivity, specificity and area under the curve (AUC)
Since 1vDM&1vDBT exposes the patient to half the dose of 2vDM&2vDBT, it might be worth considering 1vDM&1vDBT in breast cancer surveillance imaging

Summary

Introduction

Digital breast tomosynthesis (DBT) has been under consideration for its use in breast screening alone or in combination with 2D digital mammography (DM) and/or synthetic mammography (SM) for several years. There is a strong agreement that the introduction of DBT in breast cancer screening together with DM can provide several advantages, including increased specificity [5,9], reduced recall rate [6,10,11,12,13,14,15,16,17] and an increased cancer detection rate ( these increases are not statistically significant in all studies) [5,6,13,16,18,19,20]. The introduction of the two views (CC and MLO) of DBT together with the two views of DM (CC and MLO) in breast cancer imaging has some disadvantages too, including the increased interpretation time and image storage capacity, and at least double the radiation dose of that of DM [27]. The dose should ideally be kept as low as reasonably practical [28]

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