title: Diagnostic performance of tomosynthesis and breast ultrasonography in women with dense breasts: a prospective comparison study.
abstract: To compare the diagnostic performances of tomosynthesis and ultrasonography as adjunctives to digital mammography in women with dense breasts.
  
  
  
  A total of 778 women with dense breasts underwent digital mammography with tomosynthesis and ultrasonography for screening and diagnostic purposes. The findings of tomosynthesis and ultrasonography were evaluated independently. The primary endpoint was overall diagnostic accuracy determined by area under the receiver operating characteristic curve (AUC). Secondary endpoints included sensitivity, specificity, and predictive values.
  
  
  
  Of the 778 participants, 698 women (140 breast cancers) were included in the analysis. Based on the AUC findings, the non-inferiority of tomosynthesis to ultrasonography was established in the overall group as well as in all subgroups except for that comprising women with extremely dense breast composition. There were no significant differences in AUC between tomosynthesis and ultrasonography among asymptomatic participants and participants who underwent imaging for screening (0.912 vs. 0.934 [P = 0.403] and 0.987 vs. 0.950 [P = 0.270], respectively). Tomosynthesis exhibited lower sensitivity (91.4 vs. 96.4%; P = 0.039), and higher specificity (83.9 vs. 70.4%; P < 0.001) and positive predictive value (58.7 vs. 45.0%; P < 0.001) than ultrasonography.
  
  
  
  Tomosynthesis exhibits comparable performance to ultrasonography as an adjunct to mammography for diagnosis of breast cancer, except among women with extremely dense breasts.
authors.affiliation: Department of Radiology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.|Department of Radiology, Kyungpook National University Medical Center, Daegu, South Korea.
authors.forename: Won Hwa
authors.initials: WH
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea. imchangjm@gmail.com.
authors.forename: Jung Min
authors.initials: JM
authors.lastname: Chang
authors.affiliation: Division of Clinical Epidemiology, Medical Research Collaborating Center, Biomedical Research Institution, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Joongyub
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: A Jung
authors.initials: AJ
authors.lastname: Chu
authors.affiliation: Department of Radiology, Kyung Hee University Hospital, Seoul, South Korea.
authors.forename: Mirinae
authors.initials: M
authors.lastname: Seo
authors.affiliation: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Hye Mi
authors.initials: HM
authors.lastname: Gweon
authors.affiliation: Department of Radiology, Hanyang University College of Medicine, Seoul, South Korea.
authors.forename: Hye Ryoung
authors.initials: HR
authors.lastname: Koo
authors.affiliation: Department of Radiology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
authors.forename: Su Hyun
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Radiology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
authors.forename: Nariya
authors.initials: N
authors.lastname: Cho
authors.affiliation: Department of Radiology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
authors.forename: Min Sun
authors.initials: MS
authors.lastname: Bae
authors.affiliation: Department of Radiology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
authors.forename: Sung Ui
authors.initials: SU
authors.lastname: Shin
authors.affiliation: Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
authors.forename: Sung Eun
authors.initials: SE
authors.lastname: Song
authors.affiliation: Department of Radiology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
authors.forename: Woo Kyung
authors.initials: WK
authors.lastname: Moon
mesh_terms: D000328:Adult; D019540:Area Under Curve; D000071060:Breast Density; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000379:methods; D057188:Workflow
keywords: Breast neoplasm; Diagnostic performance; Mammographic density; Tomosynthesis; Ultrasonography