title: Digital breast tomosynthesis is comparable to mammographic spot views for mass characterization.
abstract: OBJECTIVE
  To determine if digital breast tomosynthesis (DBT) performs comparably to mammographic spot views (MSVs) in characterizing breast masses as benign or malignant.
  
  
  METHODS
  This IRB-approved, HIPAA-compliant reader study obtained informed consent from all subjects. Four blinded Mammography Quality Standards Act-certified academic radiologists individually evaluated DBT images and MSVs of 67 masses (30 malignant, 37 benign) in 67 women (age range, 34-88 years). Images were viewed in random order at separate counterbalanced sessions and were rated for visibility (10-point scale), likelihood of malignancy (12-point scale), and Breast Imaging Reporting and Data System (BI-RADS) classification. Differences in mass visibility were analyzed by using the Wilcoxon matched-pairs signed-ranks test. Reader performance was measured by calculating the area under the receiver operating characteristic curve (A(z)) and partial area index above a sensitivity threshold of 0.90 (A(z)(0.90)) by using likelihood of malignancy ratings. Masses categorized as BI-RADS 4 or 5 were compared with histopathologic analysis to determine true-positive results for each modality.
  
  
  RESULTS
  Mean mass visibility ratings were slightly better with DBT (range, 3.2-4.4) than with MSV (range, 3.8-4.8) for all four readers, with one reader's improvement achieving statistical significance (P = .001). The A(z) ranged 0.89-0.93 for DBT and 0.88-0.93 for MSV (P ≥ .23). The A(z)((0.90)) ranged 0.36-0.52 for DBT and 0.25-0.40 for MSV (P ≥ .20). The readers characterized seven additional malignant masses as BI-RADS 4 or 5 with DBT than with MSV, at a cost of five false-positive biopsy recommendations, with a mean of 1.8 true-positive (range, 0-3) and 1.3 false-positive (range, -1 to 4) assessments per reader.
  
  
  CONCLUSIONS
  In this small study, mass characterization in terms of visibility ratings, reader performance, and BI-RADS assessment with DBT was similar to that with MSVs. Preliminary findings suggest that MSV might not be necessary for mass characterization when performing DBT.
authors: Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, SPC 5326, Ann Arbor, MI 48109, USA. smitran@umich.edu
authors: Mitra
authors: M
authors: Noroozian
authors: Lubomir
authors: L
authors: Hadjiiski
authors: Sahand
authors: S
authors: Rahnama-Moghadam
authors: Katherine A
authors: KA
authors: Klein
authors: Deborah O
authors: DO
authors: Jeffries
authors: Renee W
authors: RW
authors: Pinsky
authors: Heang-Ping
authors: HP
authors: Chan
authors: Paul L
authors: PL
authors: Carson
authors: Mark A
authors: MA
authors: Helvie
authors: Marilyn A
authors: MA
authors: Roubidoux
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric