title: A comparison of the accuracy of film-screen mammography, full-field digital mammography, and digital breast tomosynthesis.
abstract: OBJECTIVE
  To measure the change in diagnostic accuracy of conventional film-screen mammography and full-field digital mammography (FFDM) with the addition of digital breast tomosynthesis (DBT) in women recalled for assessment following routine screening.
  
  
  METHODS
  Ethics approval for the study was granted. Women recalled for assessment following routine screening with screen-film mammography were invited to participate. Participants underwent bilateral, two-view FFDM and two-view DBT. Readers scored each lesion separately for probability of malignancy on screen-film mammography, FFDM, and then DBT. The scores were compared with the presence or absence of malignancy based on the final histopathology outcome.
  
  
  RESULTS
  Seven hundred and thirty-eight women participated (93.2% recruitment rate). Following assessment 204 (26.8%) were diagnosed as malignant (147 invasive and 57 in-situ tumours), 286 (37.68%) as benign, and 269 (35.4%) as normal. The diagnostic accuracy was evaluated by using receiving operating characteristic (ROC) and measurement of area under the curve (AUC). The AUC values demonstrated a significant (p = 0.0001) improvement in the diagnostic accuracy with the addition of DBT combined with FFDM and film-screen mammography (AUC = 0.9671) when compared to FFDM plus film-screen mammography (AUC = 0.8949) and film-screen mammography alone (AUC = 0.7882). The effect was significantly greater for soft-tissue lesions [AUC was 0.9905 with the addition of DBT and AUC was 0.9201 for FFDM with film-screen mammography combined (p = 0.0001)] compared to microcalcification [with the addition of DBT (AUC = 0.7920) and for FFDM with film-screen mammography combined (AUC = 0.7843; p = 0.3182)].
  
  
  CONCLUSIONS
  The addition of DBT increases the accuracy of mammography compared to FFDM and film-screen mammography combined and film-screen mammography alone in the assessment of screen-detected soft-tissue mammographic abnormalities.
authors.affiliation: Breast Radiology, King's College Hospital, London, UK. michael.michell@nhs.net
authors.forename: M J
authors.initials: MJ
authors.lastname: Michell
authors.forename: A
authors.initials: A
authors.lastname: Iqbal
authors.forename: R K
authors.initials: RK
authors.lastname: Wasan
authors.forename: D R
authors.initials: DR
authors.lastname: Evans
authors.forename: C
authors.initials: C
authors.lastname: Peacock
authors.forename: C P
authors.initials: CP
authors.lastname: Lawinski
authors.forename: A
authors.initials: A
authors.lastname: Douiri
authors.forename: R
authors.initials: R
authors.lastname: Wilson
authors.forename: P
authors.initials: P
authors.lastname: Whelehan
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D015588:Observer Variation; D015995:Prevalence; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D006113:United Kingdom / Q000453:epidemiology; D014962:X-Ray Film / Q000706:statistics & numerical data*; D055815:Young Adult