title: Cancer cases from ACRIN digital mammographic imaging screening trial: radiologist analysis with use of a logistic regression model.
abstract: OBJECTIVE
  To determine which factors contributed to the Digital Mammographic Imaging Screening Trial (DMIST) cancer detection results.
  
  
  METHODS
  This project was HIPAA compliant and institutional review board approved. Seven radiologist readers reviewed the film hard-copy (screen-film) and digital mammograms in DMIST cancer cases and assessed the factors that contributed to lesion visibility on both types of images. Two multinomial logistic regression models were used to analyze the combined and condensed visibility ratings assigned by the readers to the paired digital and screen-film images.
  
  
  RESULTS
  Readers most frequently attributed differences in DMIST cancer visibility to variations in image contrast--not differences in positioning or compression--between digital and screen-film mammography. The odds of a cancer being more visible on a digital mammogram--rather than being equally visible on digital and screen-film mammograms--were significantly greater for women with dense breasts than for women with nondense breasts, even with the data adjusted for patient age, lesion type, and mammography system (odds ratio, 2.28; P < .0001). The odds of a cancer being more visible at digital mammography--rather than being equally visible at digital and screen-film mammography--were significantly greater for lesions imaged with the General Electric digital mammography system than for lesions imaged with the Fischer (P = .0070) and Fuji (P = .0070) devices.
  
  
  CONCLUSIONS
  The significantly better diagnostic accuracy of digital mammography, as compared with screen-film mammography, in women with dense breasts demonstrated in the DMIST was most likely attributable to differences in image contrast, which were most likely due to the inherent system performance improvements that are available with digital mammography. The authors conclude that the DMIST results were attributable primarily to differences in the display and acquisition characteristics of the mammography devices rather than to reader variability.
authors.affiliation: Dept of Radiology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 4030 Bondurant Hall, Campus Box 7000, Chapel Hill, NC 27599-7515, USA. etta_pisano@med.unc.edu
authors.forename: Etta D
authors.initials: ED
authors.lastname: Pisano
authors.forename: Suddhasatta
authors.initials: S
authors.lastname: Acharyya
authors.forename: Elodia B
authors.initials: EB
authors.lastname: Cole
authors.forename: Helga S
authors.initials: HS
authors.lastname: Marques
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Yaffe
authors.forename: Meredith
authors.initials: M
authors.lastname: Blevins
authors.forename: Emily F
authors.initials: EF
authors.lastname: Conant
authors.forename: R Edward
authors.initials: RE
authors.lastname: Hendrick
authors.forename: Janet K
authors.initials: JK
authors.lastname: Baum
authors.forename: Laurie L
authors.initials: LL
authors.lastname: Fajardo
authors.forename: Roberta A
authors.initials: RA
authors.lastname: Jong
authors.forename: Marcia A
authors.initials: MA
authors.lastname: Koomen
authors.forename: Cherie M
authors.initials: CM
authors.lastname: Kuzmiak
authors.forename: Yeonhee
authors.initials: Y
authors.lastname: Lee
authors.forename: Dag
authors.initials: D
authors.lastname: Pavic
authors.forename: Sora C
authors.initials: SC
authors.lastname: Yoon
authors.forename: Wittaya
authors.initials: W
authors.lastname: Padungchaichote
authors.forename: Constantine
authors.initials: C
authors.lastname: Gatsonis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000379:methods*; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D011856:Radiographic Image Enhancement / Q000379:methods*; D012044:Regression Analysis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
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