Investigating the effect of adding comparisons with prior mammograms to standalone digital breast tomosynthesis...

The purpose is to retrospectively investigate how the addition of prior and concurrent mammograms affects wide-angle digital breast tomosynthesis (DBT) screening false-positive recall rates, malignancy scoring, and recall agreement.

A total of 200 cases were selected from the Malmö Breast Tomosynthesis Screening Trial. They consist of 150 recalled cases [30 true positives (TPs), 120 false positives (FPs), and 50 healthy, non-recalled true-negative (TN) cases]. The positive cases were categorized based on being recalled by either DBT, digital mammography (DM), or both. Each case had DBT, synthetic mammography (SM), and DM (prior screening round) images. Five radiologists participated in a reading study where detection, risk of malignancy, and recall were assessed. They read each case twice, once using only DBT and once using DBT together with SM and DM priors.

The results showed a significant reduction in recall rates for all FP categories, as well as for the TN cases, when adding SM and prior DM to DBT. This resulted also in a significant increase in recall agreement for these categories, with more of the negative cases being recalled by few or no readers. These categories were overall rated as appearing more malignant in the DBT reading arm. For the TP categories, there was a significant decrease in recalls for DM-recalled cancers ( $p=0.047$ ), but no significant difference for DBT-recalled cancers ( $p=0.063$ ), or DBT/DM-recalled cancers ( $p=0.208$ ).

Similar to the documented effect of priors in DM screening, we suggest that added two-dimensional priors improve the specificity of DBT screening but may reduce the sensitivity.