Won Hwa Kim MD, PhD, Presenter: Nothing to Disclose

Jung Min Chang MD, Abstract Co-Author: Nothing to Disclose

Su Hyun Lee MD, Abstract Co-Author: Nothing to Disclose

A Jung Chu MD, Abstract Co-Author: Nothing to Disclose

Min Sun Bae MD, PhD, Abstract Co-Author: Nothing to Disclose

Nariya Cho MD, Abstract Co-Author: Nothing to Disclose

Sung Ui Shin MD, Abstract Co-Author: Nothing to Disclose

Woo Kyung Moon, Abstract Co-Author: Nothing to Disclose

To compare the diagnostic performance of combined digital mammography (DM) and digital breast tomosynthesis (DBT) versus combined DM and breast ultrasound (US).

This study was approved by the institutional review board and participating women gave informed consent. A total of 771 women (mean, 48.6 years; range, 20-80), presenting for screening examination or for breast biopsy, were recruited to undergo mediolateral oblique and craniocaudal DM, DBT, and physician-performed whole breast US examination. Two independent reading phases of DM plus DBT and DM plus US were done in parallel by radiologists masked to results of the other examination results, andthe likelihood of malignancy score was separately recorded as a percentage from 0 to 100 along with the BI-RADS assessment categories. Reference standard was defined as a combination of pathology and 6-month follow-up. Diagnostic accuracy (assessed by the area under receiver operating characteristic curve), sensitivity, specificity, and positive predictive values (PPV) of DM plus DBT and DM plus US were compared.

A total of 138 cancers (mean size, 1.9cm; range 0.1cm-6cm) were identified: 125 suspicious on DM plus DBT, 135 on DM plus US, and 3 on neither. The overall diagnostic accuracy for DM plus US was significantly higher than that for DM plus DBT (0.98 vs. 0.93, P = .0011). The sensitivity was higher in DM plus US than DM plus DBT (97% [134/138] vs. 91% [125/138], P < .0001). For invasive cancers (n = 117), the sensitivity was higher in DM plus US than DM plus DBT (98% [115/117] vs. 91% [107/117], P = .0030). The specificity of DM plus DBT was higher than that of DM plus US (84% [533/632] vs. 73% [463/632]). The positive predictive value of biopsy recommendation after full diagnostic workup was 57% (125 of 218) for DM plus DBT, and 45% (135 of 303) for DM plus US. 

DM plus US had overall superior diagnostic performance than DM plus DBT and enabled the detection of more invasive cancers. However, false positives were less frequent with DM plus DBT.

Even with relative low PPV, combined reading of DM plus US will yield overall higher diagnostic performance than those of DM plus DBT, especially with superiority for detection of invasive cancer.

Kim, W, Chang, J, Lee, S, Chu, A, Bae, M, Cho, N, Shin, S, Moon, W, Combined Evaluation with Digital Mammography and Digital Breast Tomosynthesis versus Digital Mammography and Ultrasound: Interim Result of Diagnostic Performance in an Ongoing Clinical Trial.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14016835.html