Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Box 97, Hills Rd, Cambridge CB2 0QQ, England.
Radiology. 2012 Mar;262(3):788-96. doi: 10.1148/radiol.11103514. Epub 2012 Jan 24.
To compare the diagnostic accuracy of two-dimensional (2D) full-field digital mammography with that of two-view (mediolateral and craniocaudal) and single-view (mediolateral oblique) tomosynthesis in an observer study involving two institutions.
Ethical committee approval was obtained. All participating women gave informed consent. Two hundred twenty women (mean age, 56.3; range, 40-80 years) with breast density of 2-4 according to American College of Radiology criteria were recruited between November 2008 and September 2009 and underwent standard treatment plus tomosynthesis with a prototype photon-counting machine. After exclusion criteria were met, this resulted in a final test set of 130 women. Ten accredited readers classified the 130 cases (40 cancers, 24 benign lesions, and 66 normal images) using 2D mammography and two-view tomosynthesis. Another 10 readers reviewed the same cases using 2D mammography but single-view tomosynthesis. The multireader, multicase receiver operating characteristic (ROC) method was applied. The significance of the observed difference in accuracy between 2D mammography and tomosynthesis was calculated.
For diagnostic accuracy, 2D mammography performed significantly worse than two-view tomosynthesis (average area under ROC curve [AUC] = 0.772 for 2D, AUC = 0.851 for tomosynthesis, P = .021). Significant differences were found for both masses and microcalcification (P = .037 and .049). The difference in AUC between the two modalities of -0.110 was significant (P = .03) only for the five readers with the least experience (<10 years of reading); with AUC of -0.047 for the five readers with 10 years or more experience (P = .25). No significant difference (P = .79) in reader performance was seen when 2D mammography (average AUC = 0.774) was compared with single-view tomosynthesis (average AUC = 0.775).
Two-view tomosynthesis outperforms 2D mammography but only for readers with the least experience. The benefits were seen for both masses and microcalcification. No differences in classification accuracy was seen between and 2D mammography and single-view tomosynthesis.
在涉及两家机构的观察者研究中，比较二维（2D）全数字乳腺摄影与双视图（内外斜位和头尾位）和单视图（内外斜位）断层合成的诊断准确性。
获得伦理委员会批准。所有参与的女性均给予知情同意。2008 年 11 月至 2009 年 9 月期间，招募了 220 名乳腺密度为 2-4 级（根据美国放射学院标准）的女性，并接受了标准治疗加原型光子计数机断层合成。排除标准后，最终测试集为 130 名女性。10 名认可的读者使用 2D 乳房 X 线摄影和双视图断层合成对 130 例（40 例癌症、24 例良性病变和 66 例正常图像）进行分类。另外 10 名读者使用 2D 乳房 X 线摄影但单视图断层合成查看了相同的病例。应用多读者、多病例接收者操作特性（ROC）方法。计算了 2D 乳房 X 线摄影和断层合成之间准确性差异的显著性。
对于诊断准确性，2D 乳房 X 线摄影的表现明显逊于双视图断层合成（2D 的平均 ROC 曲线下面积[AUC]为 0.772，断层合成的 AUC 为 0.851，P =.021）。对于肿块和微钙化，差异均有统计学意义（P =.037 和.049）。两种方式的 AUC 差值为-0.110，具有统计学意义（P =.03），仅在经验最少（<10 年）的 5 名读者中存在；在经验为 10 年或以上的 5 名读者中，AUC 为-0.047（P =.25）。当将 2D 乳房 X 线摄影（平均 AUC = 0.774）与单视图断层合成（平均 AUC = 0.775）进行比较时，未发现读者表现的差异（P =.79）。
双视图断层合成优于 2D 乳房 X 线摄影，但仅对经验最少的读者有效。该方法对肿块和微钙化均有效。2D 乳房 X 线摄影与单视图断层合成之间未见分类准确性差异。
