title: Replacing single-view mediolateral oblique (MLO) digital mammography (DM) with synthesized mammography (SM) with digital breast tomosynthesis (DBT) images: Comparison of the diagnostic performance and radiation dose with two-view DM with or without MLO-DBT.
abstract: OBJECTIVE
  To evaluate the diagnostic performance and radiation dose of single view cranio-caudal (CC) digital mammography (DM) plus mediolateral oblique (MLO) digital breast tomosynthesis (DBT) combined with synthesized mammography (SM) in comparison with two-view DM with or without DBT.
  
  
  METHODS
  This study was approved by our institutional review board, and informed consent was obtained from 130 women. Paired two-view DM and single MLO-DBT with SM images were acquired, and four independent retrospective reading sessions of different combinations of DM, SM and DBT were performed for the presence of malignant tumors using jackknife alternative free-response receiver operator curve (JAFROC) methods. The diagnostic performances and average glandular dose (AGD) were compared between different combinations of DM, SM and DBT.
  
  
  RESULTS
  Of 159 lesions in 130 patients, 27 were malignant. When using MLO-DBT with SM instead of MLO-DM, a significantly higher sensitivity (P=0.016) and specificity (P=0.012) were noted than with two-view DM, and comparable figure of merit (FOM), sensitivity, and specificity to two-view DM with DBT were noted. The mean AGD of CC-DM plus MLO-DBT with SM was 5.78mGy±1.06 per patient, which was significantly lower than that with two-view DM with MLO-DBT (8.45mGy±1.32; P <0.001) and slightly higher than that with two-view DM (5.30mGy±0.63).
  
  
  CONCLUSIONS
  The combined use of CC-DM plus MLO-DBT with SM showed higher sensitivity and specificity to two-view DM with a smaller AGD increment and comparable diagnostic performance to that of two-view DM with MLO-DBT with a significantly lower mean AGD.
authors: Department of Radiology, Seoul National University Hospital, 03080, Republic of Korea.
authors: Hyo-Jin
authors: HJ
authors: Kang
authors: Department of Radiology, Seoul National University Hospital, 03080, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 03080, Republic of Korea. Electronic address: imchangjm@gmail.com.
authors: Jung Min
authors: JM
authors: Chang
authors: Medical Research Collaborating Center, Biomedical Research Institution, Seoul National University Hospital, 03080, Korea.
authors: Joongyub
authors: J
authors: Lee
authors: Department of Radiology, Seoul National University Hospital, 03080, Republic of Korea.
authors: Sung Eun
authors: SE
authors: Song
authors: Department of Radiology, Seoul National University Hospital, 03080, Republic of Korea.
authors: Sung Ui
authors: SU
authors: Shin
authors: Department of Radiology, Kyungpook National University Hospital, 41944, Republic of Korea.
authors: Won Hwa
authors: WH
authors: Kim
authors: Department of Radiology, Seoul National University Hospital, 03080, Republic of Korea.
authors: Min Sun
authors: MS
authors: Bae
authors: Department of Radiology, Seoul National University Hospital, 03080, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 03080, Republic of Korea; Institute of Radiation Medicine, Seoul National University College Medical Research Center, 03080, Republic of Korea.
authors: Woo Kyung
authors: WK
authors: Moon
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D012372:ROC Curve; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted; D012015:Reference Standards; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: Average glandular dose; Digital breast tomosynthesis; Digital mammography; Jackknife alternative free-response receiver operator curve methods; Synthesized mammography