Use Of Digital Breast Tomosynthesis Research Articles

Take a break: should breaks be enforced during digital breast tomosynthesis reading sessions?

ObjectivesDigital breast tomosynthesis (DBT) can improve diagnostic accuracy compared to 2D mammography, but DBT reporting is time-consuming and potentially more fatiguing. Changes in diagnostic accuracy and subjective and objective fatigue were evaluated over a DBT reporting session, and the impact of taking a reporting break was assessed.Materials and methodsForty-five National Health Service (NHS) mammography readers from 6 hospitals read a cancer-enriched set of 40 DBT cases whilst eye tracked in this prospective cohort study, from December 2020 to April 2022. Eye-blink metrics were assessed as objective fatigue measures. Twenty-one readers had a reporting break, 24 did not. Subjective fatigue questionnaires were completed before and after the session. Diagnostic accuracy and subjective and objective fatigue measures were compared between the cohorts using parametric and non-parametric significance testing.ResultsReaders had on average 10 years post-training breast screening experience and took just under 2 h (105.8 min) to report all cases. Readers without a break reported greater levels of subjective fatigue (44% vs. 33%, p = 0.04), which related to greater objective fatigue: an increased average blink duration (296 ms vs. 286 ms, p < 0.001) and a reduced eye-opening velocity (76 mm/s vs. 82 mm/s, p < 0.001). Objective fatigue increased as the trial progressed for the no break cohort only (ps < 0.001). No difference was identified in diagnostic accuracy between the groups (accuracy: 87% vs. 87%, p = 0.92).ConclusionsImplementing a break during a 2-h DBT reporting session resulted in lower levels of subjective and objective fatigue. Breaks did not impact diagnostic accuracy, which may be related to the extensive experience of the readers.Clinical relevance statementDBT is being incorporated into many mammography screening programmes. Recognising that reporting breaks are required when reading large volumes of DBT studies ensures this can be factored in when setting up reading sessions.Trial registrationClinical trials registration number: NCT03733106Key Points• Use of digital breast tomosynthesis (DBT) in breast screening programmes can cause significant reader fatigue.• The effectiveness of incorporating reading breaks into DBT reporting sessions, to reduce mammography reader fatigue, was investigated using eye tracking.• Integrating breaks into DBT reporting sessions reduced reader fatigue; however, diagnostic accuracy was unaffected.

Mammographic Screening in Routine Practice: Multisite Study of Digital Breast Tomosynthesis and Digital Mammography Screenings.

Background The use of digital breast tomosynthesis (DBT) is increasing over digital mammography (DM) following studies demonstrating lower recall rates (RRs) and higher cancer detection rates (CDRs). However, inconsistent interpretation of evidence on the risks and benefits of mammography has resulted in varying screening mammography recommendations. Purpose To evaluate screening outcomes among women in the United States who underwent routine DM or DBT mammographic screening. Materials and Methods This retrospective cohort study included women aged 40-79 years who underwent DM or DBT screening mammograms between January 2014 and December 2020. Outcomes of RR, CDR, positive predictive value of recall (PPV1), biopsy rate, and positive predictive value of biopsy (PPV3) were compared between DM and DBT with use of adjusted multivariable logistic regression models. Results A total of 2 528 063 screening mammograms from 1 100 447 women (mean age, 57 years ± 10 [SD]) were included. In crude analyses, DBT (1 693 727 screening mammograms vs 834 336 DM screening mammograms) demonstrated lower RR (10.3% [95% CI: 10.3, 10.4] for DM vs 8.9% [95% CI: 8.9, 9.0] for DBT; P < .001) and higher CDR (4.5 of 1000 screening mammograms [95% CI: 4.3, 4.6] vs 5.3 of 1000 [95% CI: 5.2, 5.5]; P < .001), PPV1 (4.3% [95% CI: 4.2, 4.5] vs 5.9% [95% CI: 5.7, 6.0]; P < .001), and biopsy rates (14.5 of 1000 screening mammograms [95% CI: 14.2, 14.7] vs 17.6 of 1000 [95% CI: 17.4, 17.8]; P < .001). PPV3 was similar between cohorts (30.0% [95% CI: 29.2, 30.9] for DM vs 29.3% [95% CI: 28.7, 29.9] for DBT; P = .16). After adjustment for age, breast density, site, and index year, associations remained stable with respect to statistical significance. Conclusion Women undergoing digital breast tomosynthesis had improved screening mammography outcomes compared with women who underwent digital mammography. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Bae and Seo in this issue.

Abstract P022: Quantitative measures of breast density and breast cancer risk prediction among black women in a screening population

Abstract Background: Although mammographic density (MD) is a strong predictor of invasive breast cancer, it has been shown to increase the discriminatory ability of existing risk prediction models only slightly. Breast density is assessed visually by radiologists according to the Breast Imaging Reporting and Data System (BI-RADS) criteria, which has been shown to lack reproducibility. Additionally, the racial diversity of women included in the previous studies was limited. Quantitative measures of breast density have been developed that automatically measure density directly from images. Our prior work found that Black women had lower BI-RADS breast density, despite having a greater quantity of dense breast tissue on average compared with white women when quantitative measures were used. The study purpose was to determine if adding quantitative breast density measures improved breast cancer risk prediction for both white and Black women compared to the Breast Cancer Risk Assessment Tool (BCRAT). Methods: A total of 16,942 women (N=6881 white, N=10061 Black) screened with full-field digital mammography (FFDM) or with a combination of FFDM and digital breast tomosynthesis (DBT) at the Hospital of the University of Pennsylvania (HUP) between September 1, 2010 to December 31, 2014 were included. Area breast density measurements including dense area and area percent density were obtained using a fully automated, validated LIBRA software. All patients were followed from the date of first screening mammogram visit until breast cancer diagnosis or end of follow up on December 31, 2019. We used the BCRA R package (v2.1) for the BCRAT (https://dceg.cancer.gov/tools/risk-assessment/bcra) to estimate the expected 5 year absolute risk for breast cancer. We evaluated the area under the curve (AUC) and calibration (observed to expected ratio, O/E) of the following models: BCRAT alone, BCRAT + BI-RADS density, BCRAT + quantitative density measures, and BCRAT + BI-RADS density + quantitative density measures. Results: There were 123 breast cancers among white and 123 breast cancers among Black women. Adding dense area and area percent density to the BCRAT alone or BCRAT plus BI-RADS density did not improve predictive accuracy for white or Black women. AUC remained close to 0.59 for white women and 0.61 for Black women in all models, with no statistically significant differences in AUCs (DeLong Test p value = 0.09). Underprediction was worse in white women than in Black women. Under-prediction of the BCRAT was reduced when adding percent density from [O/E 1.24 vs. O/E 1.17] in white women. Calibration stayed relatively the same (O/E=1.10) for Black women even when adding both quantitative MD measures. Conclusion: Our results suggest that adding quantitative area mammographic density measurements to the BCRAT does not improves breast cancer risk prediction among Black or white women. Given the increasing use of digital breast tomosynthesis (DBT), future studies should examine whether volumetric breast density measures have superior predictive value among Black women. Citation Format: Mattia A. Mahmoud, Anne Marie McCarthy, Despina Kontos, Emily Conant, Jinbo Chen, Sarah Ehsan, Lauren Pantalone, Walter Mankowski. Quantitative measures of breast density and breast cancer risk prediction among black women in a screening population. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P022.

New Horizons: Artificial Intelligence for Digital Breast Tomosynthesis.

The use of digital breast tomosynthesis (DBT) in breast cancer screening has become widely accepted, facilitating increased cancer detection and lower recall rates compared with those achieved by using full-field digital mammography (DM). However, the use of DBT, as compared with DM, raises new challenges, including a larger number of acquired images and thus longer interpretation times. While most current artificial intelligence (AI) applications are developed for DM, there are multiple potential opportunities for AI to augment the benefits of DBT. During the diagnostic steps of lesion detection, characterization, and classification, AI algorithms may not only assist in the detection of indeterminate or suspicious findings but also aid in predicting the likelihood of malignancy for a particular lesion. During image acquisition and processing, AI algorithms may help reduce radiation dose and improve lesion conspicuity on synthetic two-dimensional DM images. The use of AI algorithms may also improve workflow efficiency and decrease the radiologist's interpretation time. There has been significant growth in research that applies AI to DBT, with several algorithms approved by the U.S. Food and Drug Administration for clinical implementation. Further development of AI models for DBT has the potential to lead to improved practice efficiency and ultimately improved patient health outcomes of breast cancer screening and diagnostic evaluation. See the invited commentary by Bahl in this issue. ©RSNA, 2022.

Impact of Race, Ethnicity, and Socioeconomic Status on Digital Breast Tomosynthesis Access and Use.

HomeRadiology: Imaging CancerVol. 3, No. 4 PreviousNext Research HighlightsFree AccessImpact of Race, Ethnicity, and Socioeconomic Status on Digital Breast Tomosynthesis Access and UseKenneth Wimmer, Kimberly RayKenneth Wimmer, Kimberly RayKenneth WimmerKimberly RayPublished Online:Jul 30 2021https://doi.org/10.1148/rycan.2021219013MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Take-Away Points■ Major Focus: To evaluate sociodemographic disparities regarding access to and use of digital breast tomosynthesis (DBT) for screening.■ Key Result: From 2011 to 2017, DBT access and use became more equitable across sociodemographic groups overall, but disparities were evident during early implementation and persisted throughout the study period for Black and Asian women, as well as women with less than a high school education and those living in rural areas.■ Impact: Efforts are needed to address barriers to DBT access and uptake among underserved women.In 2011, the Food and Drug Administration approved DBT, which has been shown in large, multicenter screening studies to improve cancer detection rates and decrease recall rates when compared to conventional two-dimensional mammography. DBT adoption has been hampered by equipment costs and inconsistent insurance coverage. Lee et al hypothesized that traditionally underserved populations have limited access to DBT and that these individuals would undergo DBT less frequently when available. The authors conducted a cross-sectional study of 2 313 118 screening examinations performed from 2011 to 2017 across 92 geographically diverse centers that are members of the Breast Cancer Surveillance Consortium. Of these examinations, 87.3% were performed in community settings unaffiliated with academic centers.Overall rates of DBT use were lower among Black (37.7%), Hispanic (44%), and Asian (42.8%) women relative to White women (53.1%). Women with lower educational attainment (defined as less than high school vs college level) and those who lived in zip codes with lower median income (defined as lowest vs highest income quartile) also demonstrated relatively lower DBT use rates (40.8% vs 50.6% and 43.9% vs. 51.4%, respectively). Disparities were most pronounced during the initial years of DBT adoption. For example, the relative risk of on-site DBT access for Black relative to White women was 0.05 (95% CI: 0.03, 0.11) in 2012, but increased during the study to peak at 1.28 (95% CI: 1.05, 1.56) in 2016. However, by the end of the study period, the authors observed persistent inequities in DBT access for Asian women, as well as women with less than a high school education and those living in rural areas.Interestingly, despite an improvement in DBT access over time, Black women consistently used DBT less than White women throughout the study period. This latter observation is especially salient as Black women are more likely than White women to present with advanced-stage breast cancer at the time of diagnosis. Thus, decreased DBT use by Black women may exacerbate existing racial disparities in breast cancer outcomes.Overall, the findings of the present study are consistent with prior studies showing that minorities and those of lower socioeconomic status experience delayed and diminished benefits from advanced imaging technologies. The ability to pay out-of-pocket and awareness of the relative benefits and risks of newer screening technologies are likely to influence DBT use. As practices continue to transition to offering DBT, results of this study should inform the efforts of radiology practices and policy makers to address barriers to DBT access and uptake among underserved populations.Highlighted ArticleLee, CI, Zhu, W, Onega, T, et al. Comparative access to and use of digital breast tomosynthesis screening by women's race/ethnicity and socioeconomic status. JAMA Netw Open 2021;4(2):e2037546. doi:https://doi.org/10.1001/jamanetworkopen.2020.37546Highlighted ArticleLee, CI, Zhu, W, Onega, T, et al. Comparative access to and use of digital breast tomosynthesis screening by women’s race/ethnicity and socioeconomic status. JAMA Netw Open 2021;4(2):e2037546. doi:10.1001/jamanetworkopen.2020.37546 Crossref, Medline, Google ScholarArticle HistoryPublished online: July 30 2021 FiguresReferencesRelatedDetailsRecommended Articles Clinical Performance of Synthesized Two-dimensional Mammography Combined with Tomosynthesis in a Large Screening PopulationRadiology2017Volume: 283Issue: 1pp. 70-76Relationship between Race and Access to Newer Mammographic Technology in Women with Medicare InsuranceRadiology2022Volume: 306Issue: 2Addressing Racial Inequities in Access to State-of-the-Art Breast ImagingRadiology2022Volume: 306Issue: 2Does Reader Performance with Digital Breast Tomosynthesis Vary according to Experience with Two-dimensional Mammography?Radiology2017Volume: 283Issue: 2pp. 371-380Racial Disparities in Digital Breast Tomosynthesis ScreeningRadiology: Imaging Cancer2021Volume: 3Issue: 4See More RSNA Education Exhibits Let’s Talk about Next-Generation Breast Cancer Screening Programs: How Should We Do? What Should We Use?Digital Posters2020Encouraging Mammography Screening: Strategies for Designing a Culturally and Linguistically Targeted Breast Cancer Educational Program for a Multicultural PopulationDigital Posters2018Developing a Personalized Breast Screening Program and Centralized Breast Imaging Center in a Community-Based Health Network: A How-To Guide with Clinical OutcomesDigital Posters2018 RSNA Case Collection Invasive Lobular CarcinomaRSNA Case Collection2021Breast edemaRSNA Case Collection2021Deodorant ArtifactRSNA Case Collection2021 Vol. 3, No. 4 Metrics Altmetric Score PDF download

Digital Breast Tomosynthesis: an Overview.

The online version contains supplementary material available at 10.1007/s13193-021-01310-y.

Cancer Progress and Priorities: Breast Cancer.

Breast cancer is the most commonly diagnosed invasive cancer among women both globally and within the United States and the number one cause of cancer-related deaths among women globally ([1, 2][1]). Less than 1% of diagnosed breast cancers occur in men ([2][2]) and, therefore, male breast cancer is

Accuracy of Digital Breast Tomosynthesis for Detecting Breast Cancer in the Diagnostic Setting: A Systematic Review and Meta-Analysis.

ObjectiveTo compare the accuracy for detecting breast cancer in the diagnostic setting between the use of digital breast tomosynthesis (DBT), defined as DBT alone or combined DBT and digital mammography (DM), and the use of DM alone through a systematic review and meta-analysis.Materials and MethodsOvid-MEDLINE, Ovid-Embase, Cochrane Library and five Korean local databases were searched for articles published until March 25, 2020. We selected studies that reported diagnostic accuracy in women who were recalled after screening or symptomatic. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate random effects model was used to estimate pooled sensitivity and specificity. We compared the diagnostic accuracy between DBT and DM alone using meta-regression and subgroup analyses by modality of intervention, country, existence of calcifications, breast density, Breast Imaging Reporting and Data System category threshold, study design, protocol for participant sampling, sample size, reason for diagnostic examination, and number of readers who interpreted the studies.ResultsTwenty studies (n = 44513) that compared DBT and DM alone were included. The pooled sensitivity and specificity were 0.90 (95% confidence interval [CI] 0.86–0.93) and 0.90 (95% CI 0.84–0.94), respectively, for DBT, which were higher than 0.76 (95% CI 0.68–0.83) and 0.83 (95% CI 0.73–0.89), respectively, for DM alone (p < 0.001). The area under the summary receiver operating characteristics curve was 0.95 (95% CI 0.93–0.97) for DBT and 0.86 (95% CI 0.82–0.88) for DM alone. The higher sensitivity and specificity of DBT than DM alone were consistently noted in most subgroup and meta-regression analyses.ConclusionUse of DBT was more accurate than DM alone for the diagnosis of breast cancer. Women with clinical symptoms or abnormal screening findings could be more effectively evaluated for breast cancer using DBT, which has a superior diagnostic performance compared to DM alone.

An Effective Method to Reduce the Interpretation Time in the Clinical Use of Digital Breast Tomosynthesis

An Effective Method to Reduce the Interpretation Time in the Clinical Use of Digital Breast Tomosynthesis

A case report: usefulness of digital breast tomosynthesis(DBT) in cases with a fatty breast

A case report: usefulness of digital breast tomosynthesis(DBT) in cases with a fatty breast

Utility of whole breast ultrasound and digital tomosynthesis as an adjunct with mammography in dense breast to detect breast lesions

Mammography has been widely adopted as the primary screening tool in breast cancer detection and assessment. Screening in dense breast makes it difficult to detect lesions on screening and lowers its sensitivity to detect small lesions. Sensitivity and specificity improves with use of digital breast tomosynthesis and whole breast ultrasound in detecting lesions and also in differentiating benign and malignant breast lesions. Breast ultrasound and DBT have shown equivocal significance in detecting breast lesion on screening in the present study. The aim of the study was to evaluate utility of whole breast ultrasound and digital tomosynthesis as an adjunct with mammography in dense breast to detect breast lesions.

The incidence of missed breast cancers with the use of digital breast tomosynthesis in a symptomatic breast unit

Category: Breast

Can digital breast tomosynthesis perform better than standard digital mammography work-up in breast cancer assessment clinic?

To compare the efficacy of use of digital breast tomosynthesis (DBT) with standard digital mammography (DM) workup views in the breast cancer assessment clinic. The Tomosynthesis Assessment Clinic trial (TACT), conducted between 16 October 2014 and 19 April 2016, is an ethics-approved, monocenter, multireader, multicase split-plot reading study. After written informed consent was obtained, 144 females (age > 40 years) who were recalled to the assessment clinic were recruited into TACT. These cases (48 cancers) were randomly allocated for blinded review of (1) DM workup and (2) DBT, both in conjunction with previous DM from the screening examination. Fifteen radiologists of varying experience levels in the Australia BreastScreen Program were included in this study, wherein each radiologist read 48 cases (16 cancers) in 3 non-overlapping blocks. Diagnostic accuracy was measured by means of sensitivity, specificity, and positive (PPV) and negative predictive values (NPV). The receiver-operating characteristic area under the curve (AUC) was calculated to determine radiologists' performances. Use of DBT (AUC = 0.927) led to improved performance of the radiologists (z = 2.62, p = 0.008) compared with mammography workup (AUC = 0.872). Similarly, the sensitivity, specificity, PPV, and NPV of DBT (0.93, 0.75, 0.64, 0.96) were higher than those of the workup (0.90, 0.56, 0.49, 0.92). Most radiologists (80%) performed better with DBT than standard workup. Cancerous lesions on DBT appeared more severe (U = 33,172, p = 0.02) and conspicuous (U = 24,207, p = 0.02). There was a significant reduction in the need for additional views (χ2 = 17.63, p < 0.001) and recommendations for ultrasound (χ2 = 8.56, p = 0.003) with DBT. DBT has the potential to increase diagnostic accuracy and simplify the assessment process in the breast cancer assessment clinic. • Use of DBT in the assessment clinic results in increased diagnostic accuracy. • Use of DBT in the assessment clinic improves performance of radiologists and also increases the confidence in their decisions. • DBT may reduce the need for additional views, ultrasound imaging, and biopsy.

Tomosynthesis-detected Architectural Distortion: Management Algorithm with Radiologic-Pathologic Correlation.

As use of digital breast tomosynthesis becomes increasingly widespread, new management challenges are inevitable because tomosynthesis may reveal suspicious lesions not visible at conventional two-dimensional (2D) full-field digital mammography. Architectural distortion is a mammographic finding associated with a high positive predictive value for malignancy. It is detected more frequently at tomosynthesis than at 2D digital mammography and may even be occult at conventional 2D imaging. Few studies have focused on tomosynthesis-detected architectural distortions to date, and optimal management of these distortions has yet to be well defined. Since implementing tomosynthesis at our institution in 2011, we have learned some practical ways to assess architectural distortion. Because distortions may be subtle, tomosynthesis localization tools plus improved visualization of adjacent landmarks are crucial elements in guiding mammographic identification of elusive distortions. These same tools can guide more focused ultrasonography (US) of the breast, which facilitates detection and permits US-guided tissue sampling. Some distortions may be sonographically occult, in which case magnetic resonance imaging may be a reasonable option, both to increase diagnostic confidence and to provide a means for image-guided biopsy. As an alternative, tomosynthesis-guided biopsy, conventional stereotactic biopsy (when possible), or tomosynthesis-guided needle localization may be used to achieve tissue diagnosis. Practical uses for tomosynthesis in evaluation of architectural distortion are highlighted, potential complications are identified, and a working algorithm for management of tomosynthesis-detected architectural distortion is proposed.

Usefulness of digital breast tomosynthesis (DBT) in evaluation of pathological response after neoadjuvant chemotherapy (NAC) for breast cancer.

119 Background: Digital breast tomosynthesis (DBT) has been developed recently and it provides an advantage in detection of breast masses compared to 2D mammography (MMG) since it allows to separate the tissue layers and to noticeably reduce occlusions caused by overlapping anatomical structures. Neoadjuvant chemotherapy (NAC) has been used increasingly for the treatment of breast cancer. The imaging methods that have been used until now to assess tumor response to NAC have serious limitations. Attaining pathological complete response (pCR) is the most important predictor of long-term survival in patients receiving NAC. We assessed the radiological findings and capability of DBT to predict response to NAC in comparison with 2D MMG. Methods: 33 woman (mean age, 47.3 y.o.) having 36 lesions were recruited. Image utilizing adjunction of DBT to 2D MMG were taken for diagnosis from January, 2010 to March, 2015. Pathological subtypes were IDC (n = 34), ILC (n = 1), and IMPC (n = 1). Pathological responses of the lesions to NAC were Grade1 (n = 16), Grade2 (n = 11), and Grade3 (n = 9). The clinical image data sets were acquired with a DBT system (MAMMOMAT Inspiration, Siemens, Germany).For each patient, CC and MLO views were taken for diagnosis. With one-view 2D MMG and DBT, those radiation dose, utilizing the ACR phantom 156, were 1.20mGy and 1.80mGy. Results: The clinical response to NAC was classified into the following categories: 1) Fairly Response (FR): reduction in size of the tumor by more than 70% including Complete Response (CR), 2) Partial Response (PR): reduction in size of the tumor by 30% or more but less than 70%, 3) Stable disease (SD): reduction in size of the tumor by less than 30%. DBT findings of pathological Grade2-3 cases were all suggested FR (28/28, 100.0%) Grade3 cases were all suggested CR (9/9,100.0%). Regarding the Grade1b cases, all lesions were suggested PR (8/8, 100.0%). Regarding the Grade1a cases, 3 out of 8 (36.5%) lesions were suggested CR, and 2 out of 8 (25%) lesions suggested PR, and 3 out of 8 lesions suggested SD. Conclusions: DBT will contribute to improved diagnosis accuracy with regard to NAC response to breast cancer in comparison with 2D MMG.

Mammographic breast density: impact on breast cancer risk and implications for screening.

Mammographic breast density is rapidly becoming a hot topic in both the medical literature and the lay press. In the United States, recent legislative changes in 19 states now require radiologists to notify patients regarding breast density as well as the possible need for supplemental screening. Federal legislation regarding breast density notification has been introduced, and its passage is likely on the horizon. An understanding of the context, scientific evidence, and controversies surrounding the topic of breast density as a risk factor for breast cancer is critical for radiologists. The current state of evidence is presented regarding supplemental screening for women with dense breasts, including the use of digital breast tomosynthesis, whole-breast ultrasonography, and gadolinium-enhanced magnetic resonance imaging. A review of current practice guidelines and additional sources of information will improve radiologists' understanding of the relevant subject of breast density and enable them to respond appropriately to questions from patients, clinicians, and the media.

Comparison of Sonography versus Digital Breast Tomosynthesis to Locate Intramammary Marker Clips.

Introduction: This study aimed to compare the accuracy of sonography versus digital breast tomosynthesis to locate intramammary marker clips placed under ultrasound guidance. Patients and Methods: Fifty patients with suspicion of breast cancer (lesion diameter less than 2 cm [cT1]) had ultrasound-guided core needle biopsy with placement of a marker clip in the center of the tumor. Intramammary marker clips were subsequently located with both sonography and digital breast tomosynthesis. Results: Sonography detected no dislocation of intrammammary marker clips in 42 of 50 patients (84 %); dislocation was reported in 8 patients (16 %) with a maximum dislocation of 7 mm along the x-, y- or z-axis. Digital breast tomosynthesis showed accurate placement without dislocation of the intramammary marker clip in 48 patients (96 %); 2 patients (4 %) had a maximum clip dislocation of 3 mm along the x-, y- or z-axis (p < 0.05). Conclusion: The use of digital breast tomosynthesis could improve the accuracy when locating intramammary marker clips compared to sonography and could, in future, be used to complement or even completely replace sonography.

Digital Breast Tomosynthesis: Observer Performance Study

The purpose of this study was to compare in a retrospective observer study the diagnostic performance of full-field digital mammography (FFDM) with that of digital breast tomosynthesis. Eight experienced radiologists interpreted images from 125 selected examinations, 35 with verified findings of cancer and 90 with no finding of cancer. The four display conditions included FFDM alone, 11 low-dose projections, reconstructed digital breast tomosynthesis images, and a combined display mode of FFDM and digital breast tomosynthesis images. Observers rated examinations using the screening BI-RADS rating scale and the free-response receiver operating characteristic paradigm. Observer performance levels were measured as the proportion of examinations prompting recall of patients for further diagnostic evaluation. The results were presented in terms of true-positive fraction and false-positive fraction. Performance levels were compared among the acquisitions and reading modes. Time to view and interpret an examination also was evaluated. Use of the combination of digital breast tomosynthesis and FFDM was associated with 30% reduction in recall rate for cancer-free examinations that would have led to recall if FFDM had been used alone (p < 0.0001 for the participating radiologists, p = 0.047 in the context of a generalized population of radiologists). Use of digital breast tomosynthesis alone also tended to reduce recall rates, an average of 10%, although the observed decrease was not statistically significant (p = 0.09 for the participating radiologists). There was no convincing evidence that use of digital breast tomosynthesis alone or in combination with FFDM results in a substantial improvement in sensitivity. Use of digital breast tomosynthesis for breast imaging may result in a substantial decrease in recall rate.