One-view digital breast tomosynthesis as a stand-alone modality for breast cancer detection: do we need more?

Alejandro Rodriguez-Ruiz,Alexander J T Wanders,Ioannis Sechopoulos,Magnus Dustler,Ritse M Mann,Mechli Imhof-Tas,Susanne Lardenoije,Nico Karssemeijer,Ingvar Andersson,Kristina Lång,Albert Gubern-Merida,Sophia Zackrisson

doi:10.1007/s00330-017-5167-3

Abstract

PurposeTo compare the performance of one-view digital breast tomosynthesis (1v-DBT) to that of three other protocols combining DBT and mammography (DM) for breast cancer detection.Materials and methodsSix radiologists, three experienced with 1v-DBT in screening, retrospectively reviewed 181 cases (76 malignant, 50 benign, 55 normal) in two sessions. First, they scored sequentially: 1v-DBT (medio-lateral oblique, MLO), 1v-DBT (MLO) + 1v-DM (cranio-caudal, CC) and two-view DM + DBT (2v-DM+2v-DBT). The second session involved only 2v-DM. Lesions were scored using BI-RADS® and level of suspiciousness (1–10). Sensitivity, specificity, receiver operating characteristic (ROC) and jack-knife alternative free-response ROC (JAFROC) were computed.ResultsOn average, 1v-DBT was non-inferior to any of the other protocols in terms of JAFROC figure-of-merit, area under ROC curve, sensitivity or specificity (p>0.391). While readers inexperienced with 1v-DBT screening improved their sensitivity when adding more images (69–79 %, p=0.019), experienced readers showed similar sensitivity (76 %) and specificity (70 %) between 1v-DBT and 2v-DM+2v-DBT (p=0.482). Subanalysis by lesion type and breast density showed no difference among modalities.ConclusionDetection performance with 1v-DBT is not statistically inferior to 2v-DM or to 2v-DM+2v-DBT; its use as a stand-alone modality might be sufficient for readers experienced with this protocol.Key points• One-view breast tomosynthesis is not inferior to two-view digital mammography.• One-view DBT is not inferior to 2-view DM plus 2-view DBT.• Training may lead to 1v-DBT being sufficient for screening.

Highlights

Digital breast tomosynthesis (DBT) improves breast cancer detection and diagnosis compared to digital mammography (DM) [1,2,3,4,5,6,7,8,9]
The figure of merit (FoM) for 1v-DBT was similar to 2vDM and slightly lower than for the rest, while it was comparable between experienced and inexperienced readers with 1vDBT
A small difference was found in the jack-knife alternative free-response ROC (JAFROC) FoM between experienced and inexperienced observers, the latter performing slightly better with 2v-DM

Summary

Introduction

Digital breast tomosynthesis (DBT) improves breast cancer detection and diagnosis compared to digital mammography (DM) [1,2,3,4,5,6,7,8,9]. Instead of resulting in a two-dimensional (2D) image of the compressed breast as in DM, DBT acquires several low-dose 2D projections over a limited angular range, which are used to reconstruct a pseudo-3D image of the breast [10]. The main arguments for performing DM in addition to DBT are comparisons with prior mammograms, as well as results of some early studies that suggest that DBT is inferior for calcification detection and characterization [12, 13]. The replacement of DM with synthetic 2D mammograms generated from DBT volumes allows for comparison with priors and reduces the radiation dose, while providing similar diagnostic performance to DM [17,18,19]. The ongoing evolution of the technique suggests the possibility of using DBT as a standalone modality

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