title: Digital breast tomosynthesis: observer performance study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Use of digital breast tomosynthesis for breast imaging may result in a substantial decrease in recall rate.
authors.affiliation: Radiology Imaging Research, Department of Radiology, University of Pittsburgh, 3362 Fifth Ave., Rm. 223 FARP Bldg., Pittsburgh, PA 15213, USA. gurd@upmc.edu
authors.forename: David
authors.initials: D
authors.lastname: Gur
authors.forename: Gordon S
authors.initials: GS
authors.lastname: Abrams
authors.forename: Denise M
authors.initials: DM
authors.lastname: Chough
authors.forename: Marie A
authors.initials: MA
authors.lastname: Ganott
authors.forename: Christiane M
authors.initials: CM
authors.lastname: Hakim
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Perrin
authors.forename: Grace Y
authors.initials: GY
authors.lastname: Rathfon
authors.forename: Jules H
authors.initials: JH
authors.lastname: Sumkin
authors.forename: Margarita L
authors.initials: ML
authors.lastname: Zuley
authors.forename: Andriy I
authors.initials: AI
authors.lastname: Bandos
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D003626:Data Display; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008327:Mammography / Q000379:methods*; D015588:Observer Variation; D011237:Predictive Value of Tests; D012372:ROC Curve; D011856:Radiographic Image Enhancement; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013647:Task Performance and Analysis; D014057:Tomography, X-Ray Computed