title: Breast mass characterization using 3-dimensional automated ultrasound as an adjunct to digital breast tomosynthesis: a pilot study.
abstract: OBJECTIVE
  The purpose of this study was to retrospectively evaluate the effect of 3-dimensional automated ultrasound (3D-AUS) as an adjunct to digital breast tomosynthesis (DBT) on radiologists' performance and confidence in discriminating malignant and benign breast masses.
  
  
  METHODS
  Two-view DBT (craniocaudal and mediolateral oblique or lateral) and single-view 3D-AUS images were acquired from 51 patients with subsequently biopsy-proven masses (13 malignant and 38 benign). Six experienced radiologists rated, on a 13-point scale, the likelihood of malignancy of an identified mass, first by reading the DBT images alone, followed immediately by reading the DBT images with automatically coregistered 3D-AUS images. The diagnostic performance of each method was measured using receiver operating characteristic (ROC) curve analysis and changes in sensitivity and specificity with the McNemar test. After each reading, radiologists took a survey to rate their confidence level in using DBT alone versus combined DBT/3D-AUS as potential screening modalities.
  
  
  RESULTS
  The 6 radiologists had an average area under the ROC curve of 0.92 for both modalities (range, 0.89-0.97 for DBT and 0.90-0.94 for DBT/3D-AUS). With a Breast Imaging Reporting and Data System rating of 4 as the threshold for biopsy recommendation, the average sensitivity of the radiologists increased from 96% to 100% (P > .08) with 3D-AUS, whereas the specificity decreased from 33% to 25% (P > .28). Survey responses indicated increased confidence in potentially using DBT for screening when 3D-AUS was added (P < .05 for each reader).
  
  
  CONCLUSIONS
  In this initial reader study, no significant difference in ROC performance was found with the addition of 3D-AUS to DBT. However, a trend to improved discrimination of malignancy was observed when adding 3D-AUS. Radiologists' confidence also improved with DBT/3DAUS compared to DBT alone.
authors.affiliation: Department of Radiology, University of Michigan Medical Center, 3218A Medical Science Building I, 1301 Catherine St, Ann Arbor, MI 48109, USA. fpadilla@umich.edu
authors.forename: Frederic
authors.initials: F
authors.lastname: Padilla
authors.forename: Marilyn A
authors.initials: MA
authors.lastname: Roubidoux
authors.forename: Chintana
authors.initials: C
authors.lastname: Paramagul
authors.forename: Sumedha P
authors.initials: SP
authors.lastname: Sinha
authors.forename: Mitchell M
authors.initials: MM
authors.lastname: Goodsitt
authors.forename: Gerald L
authors.initials: GL
authors.lastname: Le Carpentier
authors.forename: Heang-Ping
authors.initials: HP
authors.lastname: Chan
authors.forename: Lubomir M
authors.initials: LM
authors.lastname: Hadjiiski
authors.forename: J Brian
authors.initials: JB
authors.lastname: Fowlkes
authors.forename: Annette D
authors.initials: AD
authors.lastname: Joe
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Klein
authors.forename: Alexis V
authors.initials: AV
authors.lastname: Nees
authors.forename: Mitra
authors.initials: M
authors.lastname: Noroozian
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Patterson
authors.forename: Renee W
authors.initials: RW
authors.lastname: Pinsky
authors.forename: Fong Ming
authors.initials: FM
authors.lastname: Hooi
authors.forename: Paul L
authors.initials: PL
authors.lastname: Carson
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D019047:Phantoms, Imaging; D010865:Pilot Projects; D012372:ROC Curve; D011856:Radiographic Image Enhancement / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012984:Software; D016217:Ultrasonography, Mammary / Q000379:methods*