One view or two views for wide-angle tomosynthesis with synthetic mammography in the assessment setting?

Paola Clauser; Pascal A T Baltzer; Panagiotis Kapetas; Ramona Woitek; Michael Weber; Federica Leone; Maria Bernathova; Thomas H Helbich

doi:10.1007/s00330-021-08079-2

One view or two views for wide-angle tomosynthesis with synthetic mammography in the assessment setting?

Eur Radiol. 2022 Jan;32(1):661-670. doi: 10.1007/s00330-021-08079-2. Epub 2021 Jul 29.

Authors

Paola Clauser¹, Pascal A T Baltzer², Panagiotis Kapetas², Ramona Woitek², Michael Weber³, Federica Leone⁴, Maria Bernathova², Thomas H Helbich²

Affiliations

¹ Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna/General Hospital Vienna, Waehringer Guertel 18-20, Vienna, Austria. clauser.p@hotmail.it.
² Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna/General Hospital Vienna, Waehringer Guertel 18-20, Vienna, Austria.
³ Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
⁴ Ospedale Luigi Sacco - Polo Universitario, via G.B. Grassi 74, 20157, Milan, Italy.

Abstract

Objectives: To evaluate the diagnostic performance in the assessment setting of three protocols: one-view wide-angle digital breast tomosynthesis (WA-DBT) with synthetic mammography (SM), two-view WA-DBT/SM, and two-view digital mammography (DM).

Methods: Included in this retrospective study were patients who underwent bilateral two-view DM and WA-DBT. SM were reconstructed from the WA-DBT data. The standard of reference was histology and/or 2 years follow-up. Included were 205 women with 179 lesions (89 malignant, 90 benign). Four blinded readers randomly evaluated images to assess density, lesion type, and level of suspicion according to BI-RADS. Three protocols were evaluated: two-view DM, one-view (mediolateral oblique) WA-DBT/SM, and two-view WA-DBT/SM. Detection rate, sensitivity, specificity, and accuracy were calculated and compared using multivariate analysis. Reading time was assessed.

Results: The detection rate was higher with two-view WA-DBT/SM (p = 0.063). Sensitivity was higher for two-view WA-DBT/SM compared to two-view DM (p = 0.001) and one-view WA-DBT/SM (p = 0.058). No significant differences in specificity were found. Accuracy was higher with both one-view WA-DBT/SM and two-view WA-DBT/SM compared to DM (p = 0.003 and > 0.001, respectively). Accuracy did not differ between one- and two-view WA-DBT/SM. Two-view WA-DBT/SM performed better for masses and asymmetries. Reading times were significantly longer when WA-DBT was evaluated.

Conclusions: One-view and two-view WA-DBT/SM can achieve a higher diagnostic performance compared to two-view DM. The detection rate and sensitivity were highest with two-view WA-DBT/SM. Two-view WA-DBT/SM appears to be the most appropriate tool for the assessment of breast lesions.

Key points: • Detection rate with two-view wide-angle digital breast tomosynthesis (WA-DBT) is significantly higher than with two-view digital mammography in the assessment setting. • Diagnostic accuracy of one-view and two-view WA-DBT with synthetic mammography (SM) in the assessment setting is higher than that of two-view digital mammography. • Compared to one-view WA-DBT with SM, two-view WA-DBT with SM seems to be the most appropriate tool for the assessment of breast lesions.

Keywords: 3D mammography; Breast cancer; Digital breast tomosynthesis; Mammography.

MeSH terms

Breast / diagnostic imaging
Breast Neoplasms* / diagnostic imaging
Female
Histological Techniques
Humans
Mammography
Paraganglioma*
Retrospective Studies
Sensitivity and Specificity