Two-view digital breast tomosynthesis screening with synthetically reconstructed projection images: comparison with digital breast tomosynthesis with full-field digital mammographic images.
OBJECTIVE
To compare the performance of two versions of reconstructed two-dimensional (2D) images in combination with digital breast tomosynthesis (DBT) versus the performance of standard full-field digital mammography (FFDM) plus DBT.


METHODS
This trial had ethical committee approval, and all participants gave written informed consent. Examinations (n = 24 901) in women between the ages of 50 and 69 years (mean age, 59.2 years) were interpreted prospectively as part of a screening trial that included independent interpretations of FFDM plus DBT and reconstructed 2D images plus DBT. Reconstructed 2D images do not require radiation exposure. Using analyses for binary data that accounted for correlated interpretations and were adjusted for reader-specific volume, two versions (initial and current) of reconstructed 2D images used during trial periods 1 (from November 22, 2010, to December 21, 2011; 12 631 women) and 2 (from January 20, 2012, to December 19, 2012; 12 270 women) were compared in terms of cancer detection and false-positive rates with the corresponding FFDM plus DBT interpretations.


RESULTS
Cancer detection rates were 8.0, 7.4, 7.8, and 7.7 per 1000 screening examinations for FFDM plus DBT in period 1, initial reconstructed 2D images plus DBT in period 1, FFDM plus DBT in period 2, and current reconstructed 2D images plus DBT in period 2, respectively. False-positive scores were 5.3%, 4.6%, 4.6%, and 4.5%, respectively. Corresponding reader-adjusted paired comparisons of false-positive scores revealed significant differences for period 1 (P = .012) but not for period 2 (ratio = 0.99; 95% confidence interval: 0.88, 1.11; P = .85).


CONCLUSIONS
The combination of current reconstructed 2D images and DBT performed comparably to FFDM plus DBT and is adequate for routine clinical use when interpreting screening mammograms.
From the Department of Radiology, Oslo University Hospital Ullevaal, University of Oslo, Kirkeveien 166, N-0407 Oslo, Norway (P.S., E.B.E., I.N.J., M.K., U.H., M.I., R.G.); Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pa (A.I.B.); Curato Roentgen Institute, Oslo, Norway (U.E.); and Institute of Population-based Cancer Research, the Cancer Registry, Oslo, Norway (S.H.).
Per
P
Skaane
Andriy I
AI
Bandos
Ellen B
EB
Eben
Ingvild N
IN
Jebsen
Mona
M
Krager
Unni
U
Haakenaasen
Ulrika
U
Ekseth
Mina
M
Izadi
Solveig
S
Hofvind
Randi
R
Gullien
D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008403:Mass Screening; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011446:Prospective Studies; D011829:Radiation Dosage; D011856:Radiographic Image Enhancement / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D012042:Registries