title: Breast Cancer: Computer-aided Detection with Digital Breast Tomosynthesis.
abstract: OBJECTIVE
  To evaluate a commercial tomosynthesis computer-aided detection (CAD) system in an independent, multicenter dataset.
  
  
  METHODS
  Diagnostic and screening tomosynthesis mammographic examinations (n = 175; cranial caudal and mediolateral oblique) were randomly selected from a previous institutional review board-approved trial. All subjects gave informed consent. Examinations were performed in three centers and included 123 patients, with 132 biopsy-proven screening-detected cancers, and 52 examinations with negative results at 1-year follow-up. One hundred eleven lesions were masses and/or microcalcifications (72 masses, 22 microcalcifications, 17 masses with microcalcifications) and 21 were architectural distortions. Lesions were annotated by radiologists who were aware of all available reports. CAD performance was assessed as per-lesion sensitivity and false-positive results per volume in patients with negative results.
  
  
  RESULTS
  Use of the CAD system showed per-lesion sensitivity of 89% (99 of 111; 95% confidence interval: 81%, 94%), with 2.7 ± 1.8 false-positive rate per view, 62 of 72 lesions detected were masses, 20 of 22 were microcalcification clusters, and 17 of 17 were masses with microcalcifications. Overall, 37 of 39 microcalcification clusters (95% sensitivity, 95% confidence interval: 81%, 99%) and 79 of 89 masses (89% sensitivity, 95% confidence interval: 80%, 94%) were detected with the CAD system. On average, 0.5 false-positive rate per view were microcalcification clusters, 2.1 were masses, and 0.1 were masses and microcalcifications.
  
  
  CONCLUSIONS
  A digital breast tomosynthesis CAD system can allow detection of a large percentage (89%, 99 of 111) of breast cancers manifesting as masses and microcalcification clusters, with an acceptable false-positive rate (2.7 per breast view). Further studies with larger datasets acquired with equipment from multiple vendors are needed to replicate the findings and to study the interaction of radiologists and CAD systems.
authors.affiliation: From the Department of Research and Development, im3D, Via Lessolo 3, 10153 Turin, Italy (L.M., D.S., S.A., S.D., D.P., A.B.); Department of Radiology, University of Turin, Turin, Italy (M.D., G.M., P.F.); Department of Diagnostic Imaging and Radiation Therapy, Radiology University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy (M.D., G.M., P.F.); Unità di Radiologia, IRCCS Policlinico S. Donato, Milan, Italy (L.C.); C.d.C. Paideia, Rome, Italy (B.P.); and Department of Radiology, Sant'Anna Hospital, Turin, Italy (V.M.).
authors.forename: Lia
authors.initials: L
authors.lastname: Morra
authors.affiliation: From the Department of Research and Development, im3D, Via Lessolo 3, 10153 Turin, Italy (L.M., D.S., S.A., S.D., D.P., A.B.); Department of Radiology, University of Turin, Turin, Italy (M.D., G.M., P.F.); Department of Diagnostic Imaging and Radiation Therapy, Radiology University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy (M.D., G.M., P.F.); Unità di Radiologia, IRCCS Policlinico S. Donato, Milan, Italy (L.C.); C.d.C. Paideia, Rome, Italy (B.P.); and Department of Radiology, Sant'Anna Hospital, Turin, Italy (V.M.).
authors.forename: Daniela
authors.initials: D
authors.lastname: Sacchetto
authors.affiliation: From the Department of Research and Development, im3D, Via Lessolo 3, 10153 Turin, Italy (L.M., D.S., S.A., S.D., D.P., A.B.); Department of Radiology, University of Turin, Turin, Italy (M.D., G.M., P.F.); Department of Diagnostic Imaging and Radiation Therapy, Radiology University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy (M.D., G.M., P.F.); Unità di Radiologia, IRCCS Policlinico S. Donato, Milan, Italy (L.C.); C.d.C. Paideia, Rome, Italy (B.P.); and Department of Radiology, Sant'Anna Hospital, Turin, Italy (V.M.).
authors.forename: Manuela
authors.initials: M
authors.lastname: Durando
authors.affiliation: From the Department of Research and Development, im3D, Via Lessolo 3, 10153 Turin, Italy (L.M., D.S., S.A., S.D., D.P., A.B.); Department of Radiology, University of Turin, Turin, Italy (M.D., G.M., P.F.); Department of Diagnostic Imaging and Radiation Therapy, Radiology University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy (M.D., G.M., P.F.); Unità di Radiologia, IRCCS Policlinico S. Donato, Milan, Italy (L.C.); C.d.C. Paideia, Rome, Italy (B.P.); and Department of Radiology, Sant'Anna Hospital, Turin, Italy (V.M.).
authors.forename: Silvano
authors.initials: S
authors.lastname: Agliozzo
authors.affiliation: From the Department of Research and Development, im3D, Via Lessolo 3, 10153 Turin, Italy (L.M., D.S., S.A., S.D., D.P., A.B.); Department of Radiology, University of Turin, Turin, Italy (M.D., G.M., P.F.); Department of Diagnostic Imaging and Radiation Therapy, Radiology University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy (M.D., G.M., P.F.); Unità di Radiologia, IRCCS Policlinico S. Donato, Milan, Italy (L.C.); C.d.C. Paideia, Rome, Italy (B.P.); and Department of Radiology, Sant'Anna Hospital, Turin, Italy (V.M.).
authors.forename: Luca Alessandro
authors.initials: LA
authors.lastname: Carbonaro
authors.affiliation: From the Department of Research and Development, im3D, Via Lessolo 3, 10153 Turin, Italy (L.M., D.S., S.A., S.D., D.P., A.B.); Department of Radiology, University of Turin, Turin, Italy (M.D., G.M., P.F.); Department of Diagnostic Imaging and Radiation Therapy, Radiology University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy (M.D., G.M., P.F.); Unità di Radiologia, IRCCS Policlinico S. Donato, Milan, Italy (L.C.); C.d.C. Paideia, Rome, Italy (B.P.); and Department of Radiology, Sant'Anna Hospital, Turin, Italy (V.M.).
authors.forename: Silvia
authors.initials: S
authors.lastname: Delsanto
authors.affiliation: From the Department of Research and Development, im3D, Via Lessolo 3, 10153 Turin, Italy (L.M., D.S., S.A., S.D., D.P., A.B.); Department of Radiology, University of Turin, Turin, Italy (M.D., G.M., P.F.); Department of Diagnostic Imaging and Radiation Therapy, Radiology University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy (M.D., G.M., P.F.); Unità di Radiologia, IRCCS Policlinico S. Donato, Milan, Italy (L.C.); C.d.C. Paideia, Rome, Italy (B.P.); and Department of Radiology, Sant'Anna Hospital, Turin, Italy (V.M.).
authors.forename: Barbara
authors.initials: B
authors.lastname: Pesce
authors.affiliation: From the Department of Research and Development, im3D, Via Lessolo 3, 10153 Turin, Italy (L.M., D.S., S.A., S.D., D.P., A.B.); Department of Radiology, University of Turin, Turin, Italy (M.D., G.M., P.F.); Department of Diagnostic Imaging and Radiation Therapy, Radiology University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy (M.D., G.M., P.F.); Unità di Radiologia, IRCCS Policlinico S. Donato, Milan, Italy (L.C.); C.d.C. Paideia, Rome, Italy (B.P.); and Department of Radiology, Sant'Anna Hospital, Turin, Italy (V.M.).
authors.forename: Diego
authors.initials: D
authors.lastname: Persano
authors.affiliation: From the Department of Research and Development, im3D, Via Lessolo 3, 10153 Turin, Italy (L.M., D.S., S.A., S.D., D.P., A.B.); Department of Radiology, University of Turin, Turin, Italy (M.D., G.M., P.F.); Department of Diagnostic Imaging and Radiation Therapy, Radiology University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy (M.D., G.M., P.F.); Unità di Radiologia, IRCCS Policlinico S. Donato, Milan, Italy (L.C.); C.d.C. Paideia, Rome, Italy (B.P.); and Department of Radiology, Sant'Anna Hospital, Turin, Italy (V.M.).
authors.forename: Giovanna
authors.initials: G
authors.lastname: Mariscotti
authors.affiliation: From the Department of Research and Development, im3D, Via Lessolo 3, 10153 Turin, Italy (L.M., D.S., S.A., S.D., D.P., A.B.); Department of Radiology, University of Turin, Turin, Italy (M.D., G.M., P.F.); Department of Diagnostic Imaging and Radiation Therapy, Radiology University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy (M.D., G.M., P.F.); Unità di Radiologia, IRCCS Policlinico S. Donato, Milan, Italy (L.C.); C.d.C. Paideia, Rome, Italy (B.P.); and Department of Radiology, Sant'Anna Hospital, Turin, Italy (V.M.).
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Marra
authors.affiliation: From the Department of Research and Development, im3D, Via Lessolo 3, 10153 Turin, Italy (L.M., D.S., S.A., S.D., D.P., A.B.); Department of Radiology, University of Turin, Turin, Italy (M.D., G.M., P.F.); Department of Diagnostic Imaging and Radiation Therapy, Radiology University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy (M.D., G.M., P.F.); Unità di Radiologia, IRCCS Policlinico S. Donato, Milan, Italy (L.C.); C.d.C. Paideia, Rome, Italy (B.P.); and Department of Radiology, Sant'Anna Hospital, Turin, Italy (V.M.).
authors.forename: Paolo
authors.initials: P
authors.lastname: Fonio
authors.affiliation: From the Department of Research and Development, im3D, Via Lessolo 3, 10153 Turin, Italy (L.M., D.S., S.A., S.D., D.P., A.B.); Department of Radiology, University of Turin, Turin, Italy (M.D., G.M., P.F.); Department of Diagnostic Imaging and Radiation Therapy, Radiology University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy (M.D., G.M., P.F.); Unità di Radiologia, IRCCS Policlinico S. Donato, Milan, Italy (L.C.); C.d.C. Paideia, Rome, Italy (B.P.); and Department of Radiology, Sant'Anna Hospital, Turin, Italy (V.M.).
authors.forename: Alberto
authors.initials: A
authors.lastname: Bert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001941:Breast Diseases / Q000000981:diagnostic imaging; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D002114:Calcinosis / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D011856:Radiographic Image Enhancement; D012680:Sensitivity and Specificity