title: Accuracy of Digital Breast Tomosynthesis for Depicting Breast Cancer Subgroups in a UK Retrospective Reading Study (TOMMY Trial).
abstract: OBJECTIVE
  To compare the diagnostic performance of two-dimensional (2D) mammography, 2D mammography plus digital breast tomosynthesis (DBT), and synthetic 2D mammography plus DBT in depicting malignant radiographic features.
  
  
  METHODS
  In this multicenter, multireader, retrospective reading study (the TOMMY trial), after written informed consent was obtained, 8869 women (age range, 29-85 years; mean, 56 years) were recruited from July 2011 to March 2013 in an ethically approved study. From these women, a reading dataset of 7060 cases was randomly allocated for independent blinded review of (a) 2D mammography images, (b) 2D mammography plus DBT images, and (c) synthetic 2D mammography plus DBT images. Reviewers had no access to results of previous examinations. Overall sensitivities and specificities were calculated for younger women and those with dense breasts.
  
  
  RESULTS
  Overall sensitivity was 87% for 2D mammography, 89% for 2D mammography plus DBT, and 88% for synthetic 2D mammography plus DBT. The addition of DBT was associated with a 34% increase in the odds of depicting cancer (odds ratio [OR] = 1.34, P = .06); however, this level did not achieve significance. For patients aged 50-59 years old, sensitivity was significantly higher (P = .01) for 2D mammography plus DBT than it was for 2D mammography. For those with breast density of 50% or more, sensitivity was 86% for 2D mammography compared with 93% for 2D mammography plus DBT (P = .03). Specificity was 57% for 2D mammography, 70% for 2D mammography plus DBT, and 72% for synthetic 2D mammography plusmDBT. Specificity was significantly higher than 2D mammography (P < .001in both cases) and was observed for all subgroups (P < .001 for all cases).
  
  
  CONCLUSIONS
  The addition of DBT increased the sensitivity of 2D mammography in patients with dense breasts and the specificity of 2D mammography for all subgroups. The use of synthetic 2D DBT demonstrated performance similar to that of standard 2D mammography with DBT. DBT is of potential benefit to screening programs, particularly in younger women with dense breasts. (©) RSNA, 2015.
authors.affiliation: From the Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, England (F.J.G., L.T., P.W.); Department of Radiology, University of Aberdeen, Aberdeen, Scotland (M.G.C.G.); Jarvis Breast Centre, Guildford, England (J.C.); North East Scotland Breast Screening Centre, Aberdeen, Scotland (K.A.D.); Department of Radiology, King's College Hospital, London, England (M.J.M.); West of Scotland Breast Screening Service, Glasgow, Scotland (H.M.D.); Department of Radiology, University Hospital South Manchester, Manchester, England (Y.Y.L.); Department of Radiology, St Batholomew's Hospital, London, England (T.S.); Department of Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (S.M.A.); East Anglian Regional Radiation Protection Service, Cambridge University Hospitals, Cambridge, England (O.M.); National Coordinating Centre for Physics of Mammography, Royal Surrey County Hospital, Guildford, England (K.C.Y.); and Centre for Cancer Prevention, Queen Mary University of London, London, England (S.W.D.).
authors.forename: Fiona J
authors.initials: FJ
authors.lastname: Gilbert
authors.affiliation: From the Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, England (F.J.G., L.T., P.W.); Department of Radiology, University of Aberdeen, Aberdeen, Scotland (M.G.C.G.); Jarvis Breast Centre, Guildford, England (J.C.); North East Scotland Breast Screening Centre, Aberdeen, Scotland (K.A.D.); Department of Radiology, King's College Hospital, London, England (M.J.M.); West of Scotland Breast Screening Service, Glasgow, Scotland (H.M.D.); Department of Radiology, University Hospital South Manchester, Manchester, England (Y.Y.L.); Department of Radiology, St Batholomew's Hospital, London, England (T.S.); Department of Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (S.M.A.); East Anglian Regional Radiation Protection Service, Cambridge University Hospitals, Cambridge, England (O.M.); National Coordinating Centre for Physics of Mammography, Royal Surrey County Hospital, Guildford, England (K.C.Y.); and Centre for Cancer Prevention, Queen Mary University of London, London, England (S.W.D.).
authors.forename: Lorraine
authors.initials: L
authors.lastname: Tucker
authors.affiliation: From the Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, England (F.J.G., L.T., P.W.); Department of Radiology, University of Aberdeen, Aberdeen, Scotland (M.G.C.G.); Jarvis Breast Centre, Guildford, England (J.C.); North East Scotland Breast Screening Centre, Aberdeen, Scotland (K.A.D.); Department of Radiology, King's College Hospital, London, England (M.J.M.); West of Scotland Breast Screening Service, Glasgow, Scotland (H.M.D.); Department of Radiology, University Hospital South Manchester, Manchester, England (Y.Y.L.); Department of Radiology, St Batholomew's Hospital, London, England (T.S.); Department of Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (S.M.A.); East Anglian Regional Radiation Protection Service, Cambridge University Hospitals, Cambridge, England (O.M.); National Coordinating Centre for Physics of Mammography, Royal Surrey County Hospital, Guildford, England (K.C.Y.); and Centre for Cancer Prevention, Queen Mary University of London, London, England (S.W.D.).
authors.forename: Maureen G C
authors.initials: MG
authors.lastname: Gillan
authors.affiliation: From the Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, England (F.J.G., L.T., P.W.); Department of Radiology, University of Aberdeen, Aberdeen, Scotland (M.G.C.G.); Jarvis Breast Centre, Guildford, England (J.C.); North East Scotland Breast Screening Centre, Aberdeen, Scotland (K.A.D.); Department of Radiology, King's College Hospital, London, England (M.J.M.); West of Scotland Breast Screening Service, Glasgow, Scotland (H.M.D.); Department of Radiology, University Hospital South Manchester, Manchester, England (Y.Y.L.); Department of Radiology, St Batholomew's Hospital, London, England (T.S.); Department of Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (S.M.A.); East Anglian Regional Radiation Protection Service, Cambridge University Hospitals, Cambridge, England (O.M.); National Coordinating Centre for Physics of Mammography, Royal Surrey County Hospital, Guildford, England (K.C.Y.); and Centre for Cancer Prevention, Queen Mary University of London, London, England (S.W.D.).
authors.forename: Paula
authors.initials: P
authors.lastname: Willsher
authors.affiliation: From the Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, England (F.J.G., L.T., P.W.); Department of Radiology, University of Aberdeen, Aberdeen, Scotland (M.G.C.G.); Jarvis Breast Centre, Guildford, England (J.C.); North East Scotland Breast Screening Centre, Aberdeen, Scotland (K.A.D.); Department of Radiology, King's College Hospital, London, England (M.J.M.); West of Scotland Breast Screening Service, Glasgow, Scotland (H.M.D.); Department of Radiology, University Hospital South Manchester, Manchester, England (Y.Y.L.); Department of Radiology, St Batholomew's Hospital, London, England (T.S.); Department of Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (S.M.A.); East Anglian Regional Radiation Protection Service, Cambridge University Hospitals, Cambridge, England (O.M.); National Coordinating Centre for Physics of Mammography, Royal Surrey County Hospital, Guildford, England (K.C.Y.); and Centre for Cancer Prevention, Queen Mary University of London, London, England (S.W.D.).
authors.forename: Julie
authors.initials: J
authors.lastname: Cooke
authors.affiliation: From the Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, England (F.J.G., L.T., P.W.); Department of Radiology, University of Aberdeen, Aberdeen, Scotland (M.G.C.G.); Jarvis Breast Centre, Guildford, England (J.C.); North East Scotland Breast Screening Centre, Aberdeen, Scotland (K.A.D.); Department of Radiology, King's College Hospital, London, England (M.J.M.); West of Scotland Breast Screening Service, Glasgow, Scotland (H.M.D.); Department of Radiology, University Hospital South Manchester, Manchester, England (Y.Y.L.); Department of Radiology, St Batholomew's Hospital, London, England (T.S.); Department of Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (S.M.A.); East Anglian Regional Radiation Protection Service, Cambridge University Hospitals, Cambridge, England (O.M.); National Coordinating Centre for Physics of Mammography, Royal Surrey County Hospital, Guildford, England (K.C.Y.); and Centre for Cancer Prevention, Queen Mary University of London, London, England (S.W.D.).
authors.forename: Karen A
authors.initials: KA
authors.lastname: Duncan
authors.affiliation: From the Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, England (F.J.G., L.T., P.W.); Department of Radiology, University of Aberdeen, Aberdeen, Scotland (M.G.C.G.); Jarvis Breast Centre, Guildford, England (J.C.); North East Scotland Breast Screening Centre, Aberdeen, Scotland (K.A.D.); Department of Radiology, King's College Hospital, London, England (M.J.M.); West of Scotland Breast Screening Service, Glasgow, Scotland (H.M.D.); Department of Radiology, University Hospital South Manchester, Manchester, England (Y.Y.L.); Department of Radiology, St Batholomew's Hospital, London, England (T.S.); Department of Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (S.M.A.); East Anglian Regional Radiation Protection Service, Cambridge University Hospitals, Cambridge, England (O.M.); National Coordinating Centre for Physics of Mammography, Royal Surrey County Hospital, Guildford, England (K.C.Y.); and Centre for Cancer Prevention, Queen Mary University of London, London, England (S.W.D.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Michell
authors.affiliation: From the Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, England (F.J.G., L.T., P.W.); Department of Radiology, University of Aberdeen, Aberdeen, Scotland (M.G.C.G.); Jarvis Breast Centre, Guildford, England (J.C.); North East Scotland Breast Screening Centre, Aberdeen, Scotland (K.A.D.); Department of Radiology, King's College Hospital, London, England (M.J.M.); West of Scotland Breast Screening Service, Glasgow, Scotland (H.M.D.); Department of Radiology, University Hospital South Manchester, Manchester, England (Y.Y.L.); Department of Radiology, St Batholomew's Hospital, London, England (T.S.); Department of Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (S.M.A.); East Anglian Regional Radiation Protection Service, Cambridge University Hospitals, Cambridge, England (O.M.); National Coordinating Centre for Physics of Mammography, Royal Surrey County Hospital, Guildford, England (K.C.Y.); and Centre for Cancer Prevention, Queen Mary University of London, London, England (S.W.D.).
authors.forename: Hilary M
authors.initials: HM
authors.lastname: Dobson
authors.affiliation: From the Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, England (F.J.G., L.T., P.W.); Department of Radiology, University of Aberdeen, Aberdeen, Scotland (M.G.C.G.); Jarvis Breast Centre, Guildford, England (J.C.); North East Scotland Breast Screening Centre, Aberdeen, Scotland (K.A.D.); Department of Radiology, King's College Hospital, London, England (M.J.M.); West of Scotland Breast Screening Service, Glasgow, Scotland (H.M.D.); Department of Radiology, University Hospital South Manchester, Manchester, England (Y.Y.L.); Department of Radiology, St Batholomew's Hospital, London, England (T.S.); Department of Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (S.M.A.); East Anglian Regional Radiation Protection Service, Cambridge University Hospitals, Cambridge, England (O.M.); National Coordinating Centre for Physics of Mammography, Royal Surrey County Hospital, Guildford, England (K.C.Y.); and Centre for Cancer Prevention, Queen Mary University of London, London, England (S.W.D.).
authors.forename: Yit Yoong
authors.initials: YY
authors.lastname: Lim
authors.affiliation: From the Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, England (F.J.G., L.T., P.W.); Department of Radiology, University of Aberdeen, Aberdeen, Scotland (M.G.C.G.); Jarvis Breast Centre, Guildford, England (J.C.); North East Scotland Breast Screening Centre, Aberdeen, Scotland (K.A.D.); Department of Radiology, King's College Hospital, London, England (M.J.M.); West of Scotland Breast Screening Service, Glasgow, Scotland (H.M.D.); Department of Radiology, University Hospital South Manchester, Manchester, England (Y.Y.L.); Department of Radiology, St Batholomew's Hospital, London, England (T.S.); Department of Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (S.M.A.); East Anglian Regional Radiation Protection Service, Cambridge University Hospitals, Cambridge, England (O.M.); National Coordinating Centre for Physics of Mammography, Royal Surrey County Hospital, Guildford, England (K.C.Y.); and Centre for Cancer Prevention, Queen Mary University of London, London, England (S.W.D.).
authors.forename: Tamara
authors.initials: T
authors.lastname: Suaris
authors.affiliation: From the Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, England (F.J.G., L.T., P.W.); Department of Radiology, University of Aberdeen, Aberdeen, Scotland (M.G.C.G.); Jarvis Breast Centre, Guildford, England (J.C.); North East Scotland Breast Screening Centre, Aberdeen, Scotland (K.A.D.); Department of Radiology, King's College Hospital, London, England (M.J.M.); West of Scotland Breast Screening Service, Glasgow, Scotland (H.M.D.); Department of Radiology, University Hospital South Manchester, Manchester, England (Y.Y.L.); Department of Radiology, St Batholomew's Hospital, London, England (T.S.); Department of Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (S.M.A.); East Anglian Regional Radiation Protection Service, Cambridge University Hospitals, Cambridge, England (O.M.); National Coordinating Centre for Physics of Mammography, Royal Surrey County Hospital, Guildford, England (K.C.Y.); and Centre for Cancer Prevention, Queen Mary University of London, London, England (S.W.D.).
authors.forename: Susan M
authors.initials: SM
authors.lastname: Astley
authors.affiliation: From the Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, England (F.J.G., L.T., P.W.); Department of Radiology, University of Aberdeen, Aberdeen, Scotland (M.G.C.G.); Jarvis Breast Centre, Guildford, England (J.C.); North East Scotland Breast Screening Centre, Aberdeen, Scotland (K.A.D.); Department of Radiology, King's College Hospital, London, England (M.J.M.); West of Scotland Breast Screening Service, Glasgow, Scotland (H.M.D.); Department of Radiology, University Hospital South Manchester, Manchester, England (Y.Y.L.); Department of Radiology, St Batholomew's Hospital, London, England (T.S.); Department of Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (S.M.A.); East Anglian Regional Radiation Protection Service, Cambridge University Hospitals, Cambridge, England (O.M.); National Coordinating Centre for Physics of Mammography, Royal Surrey County Hospital, Guildford, England (K.C.Y.); and Centre for Cancer Prevention, Queen Mary University of London, London, England (S.W.D.).
authors.forename: Oliver
authors.initials: O
authors.lastname: Morrish
authors.affiliation: From the Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, England (F.J.G., L.T., P.W.); Department of Radiology, University of Aberdeen, Aberdeen, Scotland (M.G.C.G.); Jarvis Breast Centre, Guildford, England (J.C.); North East Scotland Breast Screening Centre, Aberdeen, Scotland (K.A.D.); Department of Radiology, King's College Hospital, London, England (M.J.M.); West of Scotland Breast Screening Service, Glasgow, Scotland (H.M.D.); Department of Radiology, University Hospital South Manchester, Manchester, England (Y.Y.L.); Department of Radiology, St Batholomew's Hospital, London, England (T.S.); Department of Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (S.M.A.); East Anglian Regional Radiation Protection Service, Cambridge University Hospitals, Cambridge, England (O.M.); National Coordinating Centre for Physics of Mammography, Royal Surrey County Hospital, Guildford, England (K.C.Y.); and Centre for Cancer Prevention, Queen Mary University of London, London, England (S.W.D.).
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Young
authors.affiliation: From the Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, England (F.J.G., L.T., P.W.); Department of Radiology, University of Aberdeen, Aberdeen, Scotland (M.G.C.G.); Jarvis Breast Centre, Guildford, England (J.C.); North East Scotland Breast Screening Centre, Aberdeen, Scotland (K.A.D.); Department of Radiology, King's College Hospital, London, England (M.J.M.); West of Scotland Breast Screening Service, Glasgow, Scotland (H.M.D.); Department of Radiology, University Hospital South Manchester, Manchester, England (Y.Y.L.); Department of Radiology, St Batholomew's Hospital, London, England (T.S.); Department of Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (S.M.A.); East Anglian Regional Radiation Protection Service, Cambridge University Hospitals, Cambridge, England (O.M.); National Coordinating Centre for Physics of Mammography, Royal Surrey County Hospital, Guildford, England (K.C.Y.); and Centre for Cancer Prevention, Queen Mary University of London, London, England (S.W.D.).
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Duffy
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D003951:Diagnostic Errors; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D006113:United Kingdom