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Digital Breast Tomosynthesis Complements Two-Dimensional Synthetic Mammography for Secondary Examination of Breast
Eiji Nakajima1, Hiroko Tsunoda2, Mariko Ookura3
1Tokyo Medical University Ibaraki Medical Center, JP.
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.
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