Comparison of two-dimensional synthesized mammograms versus original digital mammograms alone and in combination with tomosynthesis images

Margarita L Zuley, Ben Guo, Victor J Catullo, Denise M Chough, Amy E Kelly, Amy H Lu, Grace Y Rathfon, Marion Lee Spangler, Jules H Sumkin, Luisa P Wallace, Andriy I Bandos, Margarita L Zuley, Ben Guo, Victor J Catullo, Denise M Chough, Amy E Kelly, Amy H Lu, Grace Y Rathfon, Marion Lee Spangler, Jules H Sumkin, Luisa P Wallace, Andriy I Bandos

Abstract

Purpose: To assess interpretation performance and radiation dose when two-dimensional synthesized mammography (SM) images versus standard full-field digital mammography (FFDM) images are used alone or in combination with digital breast tomosynthesis images.

Materials and methods: A fully crossed, mode-balanced multicase (n = 123), multireader (n = 8), retrospective observer performance study was performed by using deidentified images acquired between 2008 and 2011 with institutional review board approved, HIPAA-compliant protocols, during which each patient signed informed consent. The cohort included 36 cases of biopsy-proven cancer, 35 cases of biopsy-proven benign lesions, and 52 normal or benign cases (Breast Imaging Reporting and Data System [BI-RADS] score of 1 or 2) with negative 1-year follow-up results. Accuracy of sequentially reported probability of malignancy ratings and seven-category forced BI-RADS ratings was evaluated by using areas under the receiver operating characteristic curve (AUCs) in the random-reader analysis.

Results: Probability of malignancy-based mean AUCs for SM and FFDM images alone was 0.894 and 0.889, respectively (difference, -0.005; 95% confidence interval [CI]: -0.062, 0.054; P = .85). Mean AUC for SM with tomosynthesis and FFDM with tomosynthesis was 0.916 and 0.939, respectively (difference, 0.023; 95% CI: -0.011, 0.057; P = .19). In terms of the reader-specific AUCs, five readers performed better with SM alone versus FFDM alone, and all eight readers performed better with combined FFDM and tomosynthesis (absolute differences from 0.003 to 0.052). Similar results were obtained by using a nonparametric analysis of forced BI-RADS ratings.

Conclusion: SM alone or in combination with tomosynthesis is comparable in performance to FFDM alone or in combination with tomosynthesis and may eliminate the need for FFDM as part of a routine clinical study.

Figures

Figure 1:
Figure 1:
Overall ROC curves based on probability of malignancy ratings for individual breasts. FPF = false-positive fraction, TOMO = tomosynthesis, TPF = true-positive fraction.
Figure 1:
Figure 1:
Overall ROC curves based on probability of malignancy ratings for individual breasts. FPF = false-positive fraction, TOMO = tomosynthesis, TPF = true-positive fraction.
Figure 2:
Figure 2:
Overall breast-based ROC curves for forced BI-RADs ratings. FPF = false-positive finding, TOMO = tomosynthesis, TPF = true-positive finding.
Figure 2:
Figure 2:
Overall breast-based ROC curves for forced BI-RADs ratings. FPF = false-positive finding, TOMO = tomosynthesis, TPF = true-positive finding.
Figure 3a:
Figure 3a:
(a) FFDM and (b) SM craniocaudal images demonstrate a spiculated mass in a 58-year-old woman that proved to be invasive ductal carcinoma at biopsy.
Figure 3b:
Figure 3b:
(a) FFDM and (b) SM craniocaudal images demonstrate a spiculated mass in a 58-year-old woman that proved to be invasive ductal carcinoma at biopsy.
Figure 4a:
Figure 4a:
(a) FFDM and (b) SM craniocaudal images demonstrate segmental distribution of fine pleomorphic calcifications in a 55-year-old woman that were due to DCIS.
Figure 4b:
Figure 4b:
(a) FFDM and (b) SM craniocaudal images demonstrate segmental distribution of fine pleomorphic calcifications in a 55-year-old woman that were due to DCIS.

Source: PubMed

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