Abstract
Objective:To compare the performance of two-dimensional synthetic mammography (SM) combined with digital breast tomosynthesis (DBT) (SM/DBT) and full-field digital mammography (FFDM) including women with DBT (FFDM/DBT) undergoing secondary examination for breast cancer.Material and Methods:Out of 186 breasts, including 52 with breast cancers; FFDM/DBT and SM/DBT findings were interpreted by four expert clinicians. Radiation doses of FFDM, SM/DBT, and FFDM/DBT were determined. Inter-rater reliabilities were analyzed between readers and between FFDM/DBT and SM/DBT by Cohen’s Kappa coefficients. Diagnostic accuracy was compared between SM/DBT and FFDM/DBT by Fisher’s exact tests. Two representative cancer cases were examined for differences in the interpretation between FFDM and SM.Results:A higher radiation dose was required in FFDM/DBT than in SM/DBT (median: 1.50 mGy vs. 2.95 mGy). Inter-rater reliabilities were similar between both readers and modalities. Both sensitivity and specificity were equivalent in FFDM/DBT and SM/DBT (p = 0.874–1.00). Compared with FFDM, SM did not clearly show abnormalities with subtle margins in the two representative cancer cases.Conclusion:SM/DBT had a similar performance to FFDM/DBT in detecting breast abnormalities but requires less radiation. DBT complements SM to improve accuracy to a level equivalent to that of FFDM. Taken together, SM/DBT may be a good substitute for FFDM/DBT for the secondary examination of breast cancer.
Highlights
Previous studies have shown favorable results regarding full-field digital mammography (FFDM). combined with digital breast tomosynthesis (DBT) (FFDM/DBT) for breast cancer screening [1,2,3,4,5,6,7,8]
A higher radiation dose was required in FFDM/DBT than in synthetic mammography (SM)/DBT
SM combined with DBT (SM/DBT) had a similar performance to FFDM/DBT in detecting breast abnormalities but requires less radiation
Summary
Previous studies have shown favorable results regarding full-field digital mammography (FFDM). combined with digital breast tomosynthesis (DBT) (FFDM/DBT) for breast cancer screening [1,2,3,4,5,6,7,8]. Combined with digital breast tomosynthesis (DBT) (FFDM/DBT) for breast cancer screening [1,2,3,4,5,6,7,8]. SM combined with DBT (SM/DBT) reduces the radiation dose required due to the elimination of FFDM, while maintaining a high sensitivity [11,12,13,14,15]. DBT is currently used for secondary examination of symptomatic women or women recalled after initial screening in several countries [16, 17]. We compared the performance of FFDM/DBT and SM/DBT for secondary examination of breast cancer. We hypothesized that FFDM/DBT and SM/DBT would display similar sensitivity, specificity, and accuracy, while SM/DBT would require less radiation than FFDM/DBT
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