title: Impact of and interaction between the availability of prior examinations and DBT on the interpretation of negative and benign mammograms.
abstract: OBJECTIVE
  To assess the interaction between the availability of prior examinations and digital breast tomosynthesis (DBT) in decisions to recall a woman during interpretation of mammograms.
  
  
  METHODS
  Eight radiologists independently interpreted twice 36 mammography examinations, each of which had current and prior full-field digital mammography images (FFDM) and DBT under a Health Insurance Portability and Accountability Act-compliant, institutional review board-approved protocol (written consent waived). During the first reading, three sequential ratings were provided using FFDM only, followed by FFDM + DBT, and then followed by FFDM + DBT + priors. The second reading included FFDM only, then FFDM + priors, and then FFDM + priors + DBT. Twenty-two benign cases clinically recalled, 12 negative/benign examinations (not recalled), and two verified cancer cases were included. Recall recommendations and interaction between the effect of priors and DBT on decisions were assessed (P = .05 significance level) using generalized linear model (PROC GLIMMIX, SAS, version 9.3; SAS Institute, Cary, NC) accounting for case and reader variability.
  
  
  RESULTS
  Average recall rates in noncancer cases were significantly reduced (51%; P < .001) with the addition of DBT and with addition of priors (23%; P = .01). In absolute terms, the addition of DBT to FFDM reduced the recall rates from 0.67 to 0.42 and from 0.54 to 0.27 when DBT was available before and after priors, respectively. Recall reductions were from 0.64 to 0.54 and from 0.42 to 0.33 when priors were available before and after DBT, respectively. Regardless of the sequence in presentation, there were no statistically significant interactions between the effect of availability of DBT and priors (P = .80).
  
  
  CONCLUSIONS
  Availability of both priors and DBT are independent primary factors in reducing recall recommendations during mammographic interpretations.
authors: Department of Radiology, Magee-Womens Hospital of University of Pittsburgh Medical Center, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213. Electronic address: chakim@mail.magee.edu.
authors: Christiane M
authors: CM
authors: Hakim
authors: Department of Radiology, Magee-Womens Hospital of University of Pittsburgh Medical Center, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213.
authors: Marie I
authors: MI
authors: Anello
authors: Department of Radiology, Magee-Womens Hospital of University of Pittsburgh Medical Center, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213.
authors: Cathy S
authors: CS
authors: Cohen
authors: Department of Radiology, Magee-Womens Hospital of University of Pittsburgh Medical Center, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213.
authors: Marie A
authors: MA
authors: Ganott
authors: Department of Radiology, Magee-Womens Hospital of University of Pittsburgh Medical Center, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213.
authors: Amy H
authors: AH
authors: Lu
authors: Department of Radiology, Magee-Womens Hospital of University of Pittsburgh Medical Center, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213.
authors: Ronald L
authors: RL
authors: Perrin
authors: Department of Radiology, Magee-Womens Hospital of University of Pittsburgh Medical Center, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213.
authors: Ratan
authors: R
authors: Shah
authors: Department of Radiology, Magee-Womens Hospital of University of Pittsburgh Medical Center, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213.
authors: Marion
authors: M
authors: Lee Spangler
authors: Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
authors: Andriy I
authors: AI
authors: Bandos
authors: Department of Radiology, Radiology Imaging Research, University of Pittsburgh, Pittsburgh, PA.
authors: David
authors: D
authors: Gur
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D003131:Combined Modality Therapy / Q000379:methods; D003951:Diagnostic Errors / Q000517:prevention & control*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Breast cancer; comparison with priors; recall rates; tomosynthesis