Journal article
Can digital breast tomosynthesis perform better than standard digital mammography work-up in breast cancer assessment clinic?
European radiology, Vol.28(12), pp.5182-5194
12/2018
DOI: 10.1007/s00330-018-5473-4
PMID: 29846804
Abstract
To compare the efficacy of use of digital breast tomosynthesis (DBT) with standard digital mammography (DM) workup views in the breast cancer assessment clinic.
The Tomosynthesis Assessment Clinic trial (TACT), conducted between 16 October 2014 and 19 April 2016, is an ethics-approved, monocenter, multireader, multicase split-plot reading study. After written informed consent was obtained, 144 females (age > 40 years) who were recalled to the assessment clinic were recruited into TACT. These cases (48 cancers) were randomly allocated for blinded review of (1) DM workup and (2) DBT, both in conjunction with previous DM from the screening examination. Fifteen radiologists of varying experience levels in the Australia BreastScreen Program were included in this study, wherein each radiologist read 48 cases (16 cancers) in 3 non-overlapping blocks. Diagnostic accuracy was measured by means of sensitivity, specificity, and positive (PPV) and negative predictive values (NPV). The receiver-operating characteristic area under the curve (AUC) was calculated to determine radiologists' performances.
Use of DBT (AUC = 0.927) led to improved performance of the radiologists (z = 2.62, p = 0.008) compared with mammography workup (AUC = 0.872). Similarly, the sensitivity, specificity, PPV, and NPV of DBT (0.93, 0.75, 0.64, 0.96) were higher than those of the workup (0.90, 0.56, 0.49, 0.92). Most radiologists (80%) performed better with DBT than standard workup. Cancerous lesions on DBT appeared more severe (U = 33,172, p = 0.02) and conspicuous (U = 24,207, p = 0.02). There was a significant reduction in the need for additional views (χ
= 17.63, p < 0.001) and recommendations for ultrasound (χ
= 8.56, p = 0.003) with DBT.
DBT has the potential to increase diagnostic accuracy and simplify the assessment process in the breast cancer assessment clinic.
• Use of DBT in the assessment clinic results in increased diagnostic accuracy. • Use of DBT in the assessment clinic improves performance of radiologists and also increases the confidence in their decisions. • DBT may reduce the need for additional views, ultrasound imaging, and biopsy.
Details
- Title: Subtitle
- Can digital breast tomosynthesis perform better than standard digital mammography work-up in breast cancer assessment clinic?
- Creators
- S Mall - Faculty of Health Sciences, University of Sydney, 75 East Street, Room M204, Lidcombe, New South Wales, Australia. smal5514@uni.sydney.edu.auJ Noakes - Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaM Kossoff - Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaW Lee - Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaM McKessar - Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaA Goy - Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaJ Duncombe - Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaM Roberts - Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaB Giuffre - Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaA Miller - Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaN Bhola - Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaC Kapoor - Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaC Shearman - Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaG DaCosta - Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaS Choi - Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaJ Sterba - Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaM Kay - Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaK Bruderlin - Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaN Winarta - Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaK Donohue - Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaB Macdonell-Scott - Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaF Klijnsma - Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaK Suzuki - Northern Sydney & Central Coast BreastScreen, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaP Brennan - Faculty of Health Sciences, University of Sydney, 75 East Street, Room M204, Lidcombe, New South Wales, AustraliaC Mello-Thoms - Faculty of Health Sciences, University of Sydney, 75 East Street, Room M204, Lidcombe, New South Wales, Australia
- Resource Type
- Journal article
- Publication Details
- European radiology, Vol.28(12), pp.5182-5194
- Publisher
- Germany
- DOI
- 10.1007/s00330-018-5473-4
- PMID
- 29846804
- ISSN
- 0938-7994
- eISSN
- 1432-1084
- Language
- English
- Date published
- 12/2018
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology
- Record Identifier
- 9984051788502771
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