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

  • Breast
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Abstract

Purpose

To compare the efficacy of use of digital breast tomosynthesis (DBT) with standard digital mammography (DM) workup views in the breast cancer assessment clinic.

Materials and methods

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.

Results

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.

Conclusions

DBT has the potential to increase diagnostic accuracy and simplify the assessment process in the breast cancer assessment clinic.

Key Points

• 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.

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Abbreviations

AUC:

Area under the curve

CC:

Craniocaudal

DBT:

Digital breast tomosynthesis

DM:

Digital mammography

DMW:

Digital mammography workup views

FDA:

US Food and Drug Administration

FN:

False negative

FP:

False positive

ML:

Mediolateral

MLO:

Mediolateral oblique

MRMC:

Multi-reader multi-case

NPV:

Negative predictive values

NSW:

New South Wales

p :

p value

PPV:

Positive predictive values

SVM:

Spot-view mammogram

TACT:

Tomosynthesis Assessment Clinic Trial

TN:

True negative

TP:

True positive

U:

Test statistics for the Mann-Whitney U test

z:

Test statistics for the z-test a.k.a. Wald test

χ 2 :

Test statistics for the chi-square test

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Acknowledgements

We would like to thank Northern Sydney Local Health District, BreastScreen Northern Sydney and Central Coast, New South Wales, Australia, and the Cancer Institute New South Wales, Australia, for their support of this study. We also thank Amanda Chapman, Andrew Varnava, Carolin Skipka, Craig Cetinich, Garry Potts, Monica Connolly, and Sarah McGill for their help in this study.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Faculty of Health Sciences, University of Sydney, 75 East Street, Room M204, Lidcombe, New South Wales, Australia

    S. Mall, P. Brennan & C. Mello-Thoms

  2. Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, Australia

    J. Noakes, M. Kossoff, W. Lee, M. McKessar, A. Goy, J. Duncombe, M. Roberts, B. Giuffre, A. Miller, N. Bhola, C. Kapoor, C. Shearman, G. DaCosta, S. Choi, J. Sterba, M. Kay, K. Bruderlin, N. Winarta, K. Donohue, B. Macdonell-Scott, F. Klijnsma & K. Suzuki

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Corresponding author

Correspondence to S. Mall.

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Guarantor

The scientific guarantor of this publication is Claudia Mello-Thoms.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• case-control study

• performed at one institution

Additional information

Suneeta Mall and Jennie Noakes Joint first co-authors

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Mall, S., Noakes, J., Kossoff, M. et al. Can digital breast tomosynthesis perform better than standard digital mammography work-up in breast cancer assessment clinic?. Eur Radiol 28, 5182–5194 (2018). https://doi.org/10.1007/s00330-018-5473-4

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  • DOI: https://doi.org/10.1007/s00330-018-5473-4

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