title: The value of digital tomosynthesis in the diagnosis of suspected pulmonary lesions on chest radiography: analysis of diagnostic accuracy and confidence.
abstract: OBJECTIVE
  The aim of this study was to investigate the value of digital tomosynthesis in the diagnosis of suspected pulmonary lesions on chest radiography.
  
  
  METHODS
  Two-hundred twenty-eight patients (133 men, 95 women; mean age, 70.8 ± 11.1 years) with suspected pulmonary lesions after initial analysis of chest radiography underwent digital tomosynthesis. Two independent readers (with 3 and 20 years of experience) prospectively analyzed the chest radiographic and digital tomosynthesis images on a picture archiving and communication system workstation and proposed a diagnostic confidence score for each lesion (1 or 2 = definitely or probably extrapulmonary lesion or pseudolesion, 3 = indeterminate, 4 or 5 = probably or definitely pulmonary lesion). Chest computed tomography was the reference standard examination.
  
  
  RESULTS
  A total of 251 suspected pulmonary lesions were identified. In 71 patients, digital tomosynthesis and computed tomography did not confirm any lesion. In the remaining 157 patients, 180 lesions were identified, including 112 pulmonary and 68 extrapulmonary lesions. In 110 (reader 1) and 123 (reader 2) lesions, correct diagnoses were provided after analysis of the chest radiographs. All lesions were correctly classified after digital tomosynthesis except for 14 extrapulmonary lesions (both readers) that were misinterpreted as pulmonary and 10 (reader 1) and six (reader 2) pulmonary lesions that were misinterpreted as pleural. Digital radiography versus tomosynthesis differed in accuracy (reader 1, 43% vs 90%; reader 2, 49% vs 92%; P < .05) and confidence by area under the receiver-operating characteristic curve (reader 1, 0.788 vs 0.944; reader 2, 0.840 vs 0.997; P < .05).
  
  
  CONCLUSIONS
  Digital tomosynthesis improved diagnostic accuracy and confidence in the diagnosis of suspected pulmonary lesions on chest radiography.
authors.affiliation: Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy. equaia@yahoo.com
authors.forename: Emilio
authors.initials: E
authors.lastname: Quaia
authors.forename: Elisa
authors.initials: E
authors.lastname: Baratella
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cioffi
authors.forename: Paola
authors.initials: P
authors.lastname: Bregant
authors.forename: Stefano
authors.initials: S
authors.lastname: Cernic
authors.forename: Roberto
authors.initials: R
authors.lastname: Cuttin
authors.forename: Maria Assunta
authors.initials: MA
authors.lastname: Cova
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D011856:Radiographic Image Enhancement / Q000379:methods*; D013902:Radiography, Thoracic / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*