Division of Breast Imaging/Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, WAC 240, Boston, MA, USA.
Department of Radiology, Massachusetts General Hospital, 101 Merrimac Street, STE 1010, Boston, MA, USA.
Eur Radiol. 2019 Feb;29(2):477-484. doi: 10.1007/s00330-018-5596-7. Epub 2018 Jul 2.
To compare performance metrics between digital 2D mammography (DM) and digital breast tomosynthesis (DBT) in the diagnostic setting.
Consecutive diagnostic examinations from August 2008 to February 2011 (DM group) and from January 2013 to July 2015 (DM/DBT group) were reviewed. Core biopsy and surgical pathology results within 365 days after the mammogram were collected. Performance metrics, including cancer detection rate (CDR), abnormal interpretation rate (AIR), positive predictive value (PPV) 2, PPV3, sensitivity, and specificity were calculated. Multivariable logistic regression models were fit to compare performance metrics in the DM and DM/DBT groups while adjusting for clinical covariates.
A total of 22,883 mammograms were performed before DBT integration (DM group), and 22,824 mammograms were performed after complete DBT integration (DM/DBT group). After adjusting for multiple variables, the CDR was similar in both groups (38.2 per 1,000 examinations in the DM/DBT group versus 31.3 per 1,000 examinations in the DM group, p = 0.14); however, a higher proportion of cancers were invasive rather than in situ in the DM/DBT group [83.7% (731/873) versus 72.3% (518/716), p < 0.01]. The AIR was lower in the DM/DBT group (p < 0.01), and PPV2, PPV3, and specificity were higher in the DM/DBT group (all p = 0.01 or p < 0.01).
Complete integration of DBT into the diagnostic setting is associated with improved diagnostic performance. Increased utilization of DBT may thus result in better patient outcomes and lead to a shift in the benchmarks that have been established for DM.
• Integration of tomosynthesis into the diagnostic setting is associated with improved performance. • A higher proportion of cancers are invasive rather than in situ with digital breast tomosynthesis. • Increased utilization of tomosynthesis may lead to a shift in established benchmarks.
比较数字二维乳腺 X 线摄影术（DM）和数字乳腺断层合成术（DBT）在诊断中的性能指标。
回顾 2008 年 8 月至 2011 年 2 月（DM 组）和 2013 年 1 月至 2015 年 7 月（DM/DBT 组）连续的诊断性检查。收集在乳房 X 线摄影后 365 天内的核心活检和手术病理结果。计算了癌症检出率（CDR）、异常解释率（AIR）、阳性预测值 2（PPV2）、阳性预测值 3（PPV3）、敏感性和特异性等性能指标。在调整临床协变量后，使用多变量逻辑回归模型比较 DM 组和 DM/DBT 组的性能指标。
在 DBT 整合之前共进行了 22883 次乳房 X 线摄影（DM 组），在 DBT 完全整合后进行了 22824 次乳房 X 线摄影（DM/DBT 组）。调整多个变量后，两组的 CDR 相似（DM/DBT 组每 1000 例检查中有 38.2 例，DM 组每 1000 例检查中有 31.3 例，p=0.14）；然而，DM/DBT 组中更多的癌症为浸润性而非原位癌[83.7%（731/873）比 72.3%（518/716），p<0.01]。DM/DBT 组的 AIR 较低（p<0.01），PPV2、PPV3 和特异性在 DM/DBT 组较高（均为 p=0.01 或 p<0.01）。
DBT 完全整合到诊断环境中与诊断性能的提高有关。更多地使用 DBT 可能会带来更好的患者结局，并导致为 DM 建立的基准发生变化。
• 断层合成术整合到诊断环境中与性能的提高有关。• 数字乳腺断层合成术组中更多的癌症为浸润性而非原位癌。• 更多地使用断层合成术可能会导致既定基准的改变。
