title: Digital breast tomosynthesis as an adjunct to digital mammography for detecting and characterising invasive lobular cancers: a multi-reader study.
abstract: OBJECTIVE
  To examine the interpretive performance of digital breast tomosynthesis (DBT) as an adjunct to digital mammography (DM) compared to DM alone in a series of invasive lobular carcinomas (ILCs) and to assess whether DBT can be used to characterise ILC.
  
  
  METHODS
  A retrospective, multi-reader study was conducted of 83 mammographic examinations of women with 107 newly diagnosed ILCs ascertained at histology. Consenting women underwent both DM and DBT acquisitions. Twelve radiologists, with varying mammography experience, interpreted DM images alone, reporting lesion location, mammographic features, and malignancy probability using the Breast Imaging-Reporting and Data System (BI-RADS) categories 1-5; they then reviewed DBT images in addition to DM, and reported the same parameters. Statistical analyses compared sensitivity, false-positive rates (FPR), and interpretive performance using the receiver operating characteristics (ROC) curve and the area under the curve (AUC), for reading with DM versus DM plus DBT.
  
  
  RESULTS
  Multi-reader pooled ROC analysis for DM plus DBT yielded AUC=0.89 (95% confidence interval [CI]: 0.88-0.91), which was significantly higher (p<0.0001) than DM alone with AUC=0.84 (95% CI: 0.82-0.86). DBT plus DM significantly increased pooled sensitivity (85%) compared to DM alone (70%; p<0.0001). FPR did not vary significantly with the addition of DBT to DM. Interpreting with DBT (compared to DM alone) increased the correct identification of ILCs depicted as architectural distortions (84% versus 65%, respectively) or as masses (89% versus 70%), increasing interpretive performance for both experienced and less-experienced readers; larger gains in AUC were shown for less-experienced radiologists. Multifocal and/or multicentric and bilateral disease was more frequently identified on DM with DBT.
  
  
  CONCLUSIONS
  Adding DBT to DM significantly improved the accuracy of mammographic interpretation for ILCs and contributed to characterising disease extent.
authors.affiliation: Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Cittá della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126 Torino, Italy. Electronic address: giovanna.mariscotti@libero.it.
authors.forename: G
authors.initials: G
authors.lastname: Mariscotti
authors.affiliation: Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Cittá della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126 Torino, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Durando
authors.affiliation: Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney 2006, NSW, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Houssami
authors.affiliation: Department of Medical and Biological Sciences, Institute of Diagnostic Radiology, University of Udine, 33100 Udine, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Zuiani
authors.affiliation: Department of Radiology, Candiolo Cancer Institute - FPO, IRCCS, 10060 Candiolo, Torino, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Martincich
authors.affiliation: Department of Medical and Biological Sciences, Institute of Diagnostic Radiology, University of Udine, 33100 Udine, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Londero
authors.affiliation: Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Cittá della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126 Torino, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Caramia
authors.affiliation: Department of Medical and Biological Sciences, Institute of Diagnostic Radiology, University of Udine, 33100 Udine, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Clauser
authors.affiliation: Breast Imaging Service, Ospedale Koelliker, C.so Galileo Ferraris 256, 10100 Torino, Italy.
authors.forename: P P
authors.initials: PP
authors.lastname: Campanino
authors.affiliation: Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Cittá della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126 Torino, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Regini
authors.affiliation: U.O. Senologia Clinica e Screening Mammografico, Department of Diagnostics, Azienda Provinciale Servizi Sanitari (APSS), 38100 Trento, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Luparia
authors.affiliation: Department of Biomedical Sciences and Human Oncology, A. O. U. Città della Salute e della Scienza of Turin, University of Turin, Via Santena,7, Torino, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Castellano
authors.affiliation: Department of Surgical Sciences, University of Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, 10126 Torino, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Bergamasco
authors.affiliation: Department of Biomedical Sciences and Human Oncology, A. O. U. Città della Salute e della Scienza of Turin, University of Turin, Via Santena,7, Torino, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Sapino
authors.affiliation: Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Cittá della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126 Torino, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Fonio
authors.affiliation: Department of Medical and Biological Sciences, Institute of Diagnostic Radiology, University of Udine, 33100 Udine, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bazzocchi
authors.affiliation: Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, University of Turin, A. O. U. Cittá della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126 Torino, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Gandini
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging* / Q000473:pathology*; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D009361:Neoplasm Invasiveness; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods