title: Effect of the Availability of Prior Full-Field Digital Mammography and Digital Breast Tomosynthesis Images on the Interpretation of Mammograms.
abstract: OBJECTIVE
  To assess the effect of and interaction between the availability of prior images and digital breast tomosynthesis (DBT) images in decisions to recall women during mammogram interpretation.
  
  
  METHODS
  Verbal informed consent was obtained for this HIPAA-compliant institutional review board-approved protocol. Eight radiologists independently interpreted twice deidentified mammograms obtained in 153 women (age range, 37-83 years; mean age, 53.7 years ± 9.3 [standard deviation]) in a mode by reader by case-balanced fully crossed study. Each study consisted of current and prior full-field digital mammography (FFDM) images and DBT images that were acquired in our facility between June 2009 and January 2013. For one reading, sequential ratings were provided by using (a) current FFDM images only, (b) current FFDM and DBT images, and (c) current FFDM, DBT, and prior FFDM images. The other reading consisted of (a) current FFDM images only, (b) current and prior FFDM images, and (c) current FFDM, prior FFDM, and DBT images. Fifty verified cancer cases, 60 negative and benign cases (clinically not recalled), and 43 benign cases (clinically recalled) were included. Recall recommendations and interaction between the effect of prior FFDM and DBT images were assessed by using a generalized linear model accounting for case and reader variability.
  
  
  RESULTS
  Average recall rates in noncancer cases were significantly reduced with the addition of prior FFDM images by 34% (145 of 421) and 32% (106 of 333) without and with DBT images, respectively (P < .001). However, this recall reduction was achieved at the cost of a corresponding 7% (23 of 345) and 4% (14 of 353) reduction in sensitivity (P = .006). In contrast, availability of DBT images resulted in a smaller reduction in recall rates (false-positive interpretations) of 19% (76 of 409) and 26% (71 of 276) without and with prior FFDM images, respectively (P = .001). Availability of DBT images resulted in 4% (15 of 338) and 8% (25 of 322) increases in sensitivity, respectively (P = .007). The effects of the availability of prior FFDM images or DBT images did not significantly change regardless of the sequence in presentation (P = .81 and P = .47 for specificity and sensitivity, respectively).
  
  
  CONCLUSIONS
  The availability of prior FFDM or DBT images is a largely independent contributing factor in reducing recall recommendations during mammographic interpretation.
authors.affiliation: From the Department of Radiology, Division of Breast Imaging, Magee-Womens Hospital of UPMC, 300 Halket St, Pittsburgh, PA 15213 (C.M.H., V.J.C., D.M.C., M.A.G., A.E.K., D.D.S., J.H.S., L.P.W.); Department of Biostatistics, Graduate School of Public Health (A.I.B.), and Department of Radiology, Division of Research Imaging (D.G.), University of Pittsburgh, Pittsburgh, Pa.
authors.forename: Christiane M
authors.initials: CM
authors.lastname: Hakim
authors.affiliation: From the Department of Radiology, Division of Breast Imaging, Magee-Womens Hospital of UPMC, 300 Halket St, Pittsburgh, PA 15213 (C.M.H., V.J.C., D.M.C., M.A.G., A.E.K., D.D.S., J.H.S., L.P.W.); Department of Biostatistics, Graduate School of Public Health (A.I.B.), and Department of Radiology, Division of Research Imaging (D.G.), University of Pittsburgh, Pittsburgh, Pa.
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Catullo
authors.affiliation: From the Department of Radiology, Division of Breast Imaging, Magee-Womens Hospital of UPMC, 300 Halket St, Pittsburgh, PA 15213 (C.M.H., V.J.C., D.M.C., M.A.G., A.E.K., D.D.S., J.H.S., L.P.W.); Department of Biostatistics, Graduate School of Public Health (A.I.B.), and Department of Radiology, Division of Research Imaging (D.G.), University of Pittsburgh, Pittsburgh, Pa.
authors.forename: Denise M
authors.initials: DM
authors.lastname: Chough
authors.affiliation: From the Department of Radiology, Division of Breast Imaging, Magee-Womens Hospital of UPMC, 300 Halket St, Pittsburgh, PA 15213 (C.M.H., V.J.C., D.M.C., M.A.G., A.E.K., D.D.S., J.H.S., L.P.W.); Department of Biostatistics, Graduate School of Public Health (A.I.B.), and Department of Radiology, Division of Research Imaging (D.G.), University of Pittsburgh, Pittsburgh, Pa.
authors.forename: Marie A
authors.initials: MA
authors.lastname: Ganott
authors.affiliation: From the Department of Radiology, Division of Breast Imaging, Magee-Womens Hospital of UPMC, 300 Halket St, Pittsburgh, PA 15213 (C.M.H., V.J.C., D.M.C., M.A.G., A.E.K., D.D.S., J.H.S., L.P.W.); Department of Biostatistics, Graduate School of Public Health (A.I.B.), and Department of Radiology, Division of Research Imaging (D.G.), University of Pittsburgh, Pittsburgh, Pa.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Kelly
authors.affiliation: From the Department of Radiology, Division of Breast Imaging, Magee-Womens Hospital of UPMC, 300 Halket St, Pittsburgh, PA 15213 (C.M.H., V.J.C., D.M.C., M.A.G., A.E.K., D.D.S., J.H.S., L.P.W.); Department of Biostatistics, Graduate School of Public Health (A.I.B.), and Department of Radiology, Division of Research Imaging (D.G.), University of Pittsburgh, Pittsburgh, Pa.
authors.forename: Dilip D
authors.initials: DD
authors.lastname: Shinde
authors.affiliation: From the Department of Radiology, Division of Breast Imaging, Magee-Womens Hospital of UPMC, 300 Halket St, Pittsburgh, PA 15213 (C.M.H., V.J.C., D.M.C., M.A.G., A.E.K., D.D.S., J.H.S., L.P.W.); Department of Biostatistics, Graduate School of Public Health (A.I.B.), and Department of Radiology, Division of Research Imaging (D.G.), University of Pittsburgh, Pittsburgh, Pa.
authors.forename: Jules H
authors.initials: JH
authors.lastname: Sumkin
authors.affiliation: From the Department of Radiology, Division of Breast Imaging, Magee-Womens Hospital of UPMC, 300 Halket St, Pittsburgh, PA 15213 (C.M.H., V.J.C., D.M.C., M.A.G., A.E.K., D.D.S., J.H.S., L.P.W.); Department of Biostatistics, Graduate School of Public Health (A.I.B.), and Department of Radiology, Division of Research Imaging (D.G.), University of Pittsburgh, Pittsburgh, Pa.
authors.forename: Luisa P
authors.initials: LP
authors.lastname: Wallace
authors.affiliation: From the Department of Radiology, Division of Breast Imaging, Magee-Womens Hospital of UPMC, 300 Halket St, Pittsburgh, PA 15213 (C.M.H., V.J.C., D.M.C., M.A.G., A.E.K., D.D.S., J.H.S., L.P.W.); Department of Biostatistics, Graduate School of Public Health (A.I.B.), and Department of Radiology, Division of Research Imaging (D.G.), University of Pittsburgh, Pittsburgh, Pa.
authors.forename: Andriy I
authors.initials: AI
authors.lastname: Bandos
authors.affiliation: From the Department of Radiology, Division of Breast Imaging, Magee-Womens Hospital of UPMC, 300 Halket St, Pittsburgh, PA 15213 (C.M.H., V.J.C., D.M.C., M.A.G., A.E.K., D.D.S., J.H.S., L.P.W.); Department of Biostatistics, Graduate School of Public Health (A.I.B.), and Department of Radiology, Division of Research Imaging (D.G.), University of Pittsburgh, Pittsburgh, Pa.
authors.forename: David
authors.initials: D
authors.lastname: Gur
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001941:Breast Diseases / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies