title: Characterisation of microcalcification clusters on 2D digital mammography (FFDM) and digital breast tomosynthesis (DBT): does DBT underestimate microcalcification clusters? Results of a multicentre study.
abstract: OBJECTIVE
  To compare DBT and FFDM in the classification of microcalcification clusters (MCs) using BI-RADS.
  
  
  METHODS
  This Institutional Review Board-approved study was undertaken in three centres. A total of 107 MCs evaluated with both DBT and FFDM were randomised for prospective reading by six experienced breast radiologists and classified using BI-RADS.
  
  
  RESULTS
  The benign/malignant ratio of MC was 66/41. Of 11/107 discordant results, DBT classified MCs as R2 whereas FFDM classified them as R3 in 9 and R4 in 2. Three of these (3/107 = 2.8%) were malignant; 8 (7.5%) were nonmalignant and were correctly classified as R2 on DBT but incorrectly classified as R3 on FFDM. Estimated sensitivity and specificity, respectively, were 100% (95% CI: 91% to 100%) and 94.6% (95% CI: 86.7% to 98.5%) for FFDM and 91.1% (95% CI: 78.8% to 97.5%) and 100% (95% CI: 94.8% to 100%) for DBT. Overall intra- and interobserver agreements were 0.75 (95% CI: 0.61-0.84) and 0.73 (95% CI: 0.62-0.78).
  
  
  CONCLUSIONS
  Most MCs are scored similarly on FFDM and DBT. Although a minority (11/107) of MCs are classified differently on FFDM (benign MC classified as R3) and DBT (malignant MC classified as R2), this may have clinical relevance.
  
  
  CONCLUSIONS
  • The BI-RADS classification of MC differs for FFDM and DBT in 11/107 cases • DBT assigned lower BI-RADS classes compared to FFDM in 11 clusters • In 4/107 DBT may have missed some malignant and high-risk lesions • In 7/107 the 'underclassification' on DBT was correct, potentially avoiding unnecessary biopsies • DBT may miss a small proportion of malignant lesions.
authors.affiliation: Institute of Anatomy, Department of Experimental Medicine (DIMES), University of Genoa, Largo Rosanna Benzi 8, 16132, Genoa, Italy, albertotagliafico@gmail.com.
authors.forename: Alberto
authors.initials: A
authors.lastname: Tagliafico
authors.forename: Giovanna
authors.initials: G
authors.lastname: Mariscotti
authors.forename: Manuela
authors.initials: M
authors.lastname: Durando
authors.forename: Carmen
authors.initials: C
authors.lastname: Stevanin
authors.forename: Giulio
authors.initials: G
authors.lastname: Tagliafico
authors.forename: Lucia
authors.initials: L
authors.lastname: Martino
authors.forename: Bianca
authors.initials: B
authors.lastname: Bignotti
authors.forename: Massimo
authors.initials: M
authors.lastname: Calabrese
authors.forename: Nehmat
authors.initials: N
authors.lastname: Houssami
mesh_terms: D001941:Breast Diseases / Q000000981:diagnostic imaging*; D002114:Calcinosis / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D014056:Tomography, X-Ray / Q000379:methods*