title: Digital breast tomosynthesis versus supplemental diagnostic mammographic views for evaluation of noncalcified breast lesions.
abstract: OBJECTIVE
  To compare the diagnostic performance of breast tomosynthesis versus supplemental mammography views in classification of masses, distortions, and asymmetries.
  
  
  METHODS
  Eight radiologists who specialized in breast imaging retrospectively reviewed 217 consecutively accrued lesions by using protocols that were HIPAA compliant and institutional review board approved in 182 patients aged 31-60 years (mean, 50 years) who underwent diagnostic mammography and tomosynthesis. The lesions in the cohort included 33% (72 of 217) cancers and 67% (145 of 217) benign lesions. Eighty-four percent (182 of 217) of the lesions were masses, 11% (25 of 217) were asymmetries, and 5% (10 of 217) were distortions that were initially detected at clinical examination in 8% (17 of 217), at mammography in 80% (173 of 217), at ultrasonography (US) in 11% (25 of 217), or at magnetic resonance imaging in 1% (2 of 217). Histopathologic examination established truth in 191 lesions, US revealed a cyst in 12 lesions, and 14 lesions had a normal follow-up. Each lesion was interpreted once with tomosynthesis and once with supplemental mammographic views; both modes included the mediolateral oblique and craniocaudal views in a fully crossed and balanced design by using a five-category Breast Imaging Reporting and Data System (BI-RADS) assessment and a probability-of-malignancy score. Differences between modes were analyzed with a generalized linear mixed model for BI-RADS-based sensitivity and specificity and with modified Obuchowski-Rockette approach for probability-of-malignancy-based area under the receiver operating characteristic (ROC) curve.
  
  
  RESULTS
  Average probability-of-malignancy-based area under the ROC curve was 0.87 for tomosynthesis versus 0.83 for supplemental views (P < .001). With tomosynthesis, the false-positive rate decreased from 85% (989 of 1160) to 74% (864 of 1160) (P < .01) for cases that were rated BI-RADS category 3 or higher and from 57% (663 of 1160) to 48% (559 of 1160) for cases rated BI-RADS category 4 or 5 (P < .01), without a meaningful change in sensitivity. With tomosynthesis, more cancers were classified as BI-RADS category 5 (39% [226 of 576] vs 33% [188 of 576]; P = .017) without a decrease in specificity.
  
  
  CONCLUSIONS
  Tomosynthesis significantly improved diagnostic accuracy for noncalcified lesions compared with supplemental mammographic views.
authors.affiliation: Department of Radiology, Magee-Womens Hospital, University of Pittsburgh Medical Center, 300 Halket St, Pittsburgh, PA 15213, USA. zuleyml@upmc.edu
authors.forename: Margarita L
authors.initials: ML
authors.lastname: Zuley
authors.forename: Andriy I
authors.initials: AI
authors.lastname: Bandos
authors.forename: Marie A
authors.initials: MA
authors.lastname: Ganott
authors.forename: Jules H
authors.initials: JH
authors.lastname: Sumkin
authors.forename: Amy E
authors.initials: AE
authors.lastname: Kelly
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Catullo
authors.forename: Grace Y
authors.initials: GY
authors.lastname: Rathfon
authors.forename: Amy H
authors.initials: AH
authors.lastname: Lu
authors.forename: David
authors.initials: D
authors.lastname: Gur
mesh_terms: D000328:Adult; D001941:Breast Diseases / Q000175:diagnosis*; D002114:Calcinosis / Q000175:diagnosis; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000379:methods*; D012680:Sensitivity and Specificity