Radiology Unit, AUSL Reggio Emilia, IRCCS, Reggio Emilia, Italy.
Epidemiology Unit, AUSL Reggio Emilia, IRCCS, Reggio Emilia, Italy.
Eur Radiol. 2019 Jul;29(7):3802-3811. doi: 10.1007/s00330-018-5978-x. Epub 2019 Feb 8.
Tomosynthesis (DBT) has proven to be more sensitive than digital mammography, but it requires longer reading time. We retrospectively compared accuracy and reading times of a simplified protocol with 1-cm-thick slabs versus a standard protocol of slabs + 1-mm-spaced planes, both integrated with synthetic 2D.
We randomly selected 894 DBTs (including 12 cancers) from the experimental arm of the RETomo trial. DBTs were read by two radiologists to estimate specificity. A second set of 24 cancers (8 also present in the first set) mixed within 276 negative DBTs was read by two radiologists. In total, 28 cancers with 64 readings were used to estimate sensitivity. Radiologists read with both protocols separated by a 3-month washout. Only women that were positive at the screening reading were assessed. Variance was estimated taking into account repeated measures.
Sensitivity was 82.8% (53/64, 95% confidence interval (95% CI) 67.2-92.2) and 90.6% (95% CI 80.2-95.8) with simplified and standard protocols, respectively. In the random screening setting, specificity was 97.9% (1727/1764, 95% CI 97.1-98.5) and 96.3% (95% CI 95.3-97.1), respectively. Inter-reader agreement was 0.68 and 0.54 with simplified and standard protocols, respectively. Median reading times with simplified protocol were 20% to 30% shorter than with standard protocol.
A simplified protocol reduced reading time and false positives but may have a negative impact on sensitivity.
• The adoption of digital breast tomosynthesis (DBT) in screening, more sensitive than mammography, could be limited by its potential effect on the radiologists' workload, i.e., increased reading time and fatigue. • A DBT simplified protocol with slab only, compared to a standard protocol (slab plus planes) both integrated with synthetic 2D, reduced time and false positives but had a negative impact on sensitivity.
断层合成乳腺摄影术（DBT）已被证明比数字乳腺摄影术更敏感，但它需要更长的阅读时间。我们回顾性比较了简化协议（1 厘米厚的切片）和标准协议（切片+1 毫米间隔的平面）的准确性和阅读时间，两者都结合了合成的 2D 图像。
我们从 RETomo 试验的实验组中随机选择了 894 例 DBT（包括 12 例癌症）。两位放射科医生阅读 DBT 以估计特异性。第二组 24 例癌症（第一组中有 8 例）与 276 例阴性 DBT 混合，由两位放射科医生阅读。总共使用 28 例癌症和 64 次阅读来估计敏感性。放射科医生在阅读时使用两种协议，中间间隔 3 个月的清洗期。仅评估在筛查阅读中呈阳性的女性。考虑到重复测量，估计了方差。
简化协议和标准协议的敏感性分别为 82.8%（53/64，95%置信区间[95%CI]67.2-92.2）和 90.6%（95%CI 80.2-95.8）。在随机筛查设置中，特异性分别为 97.9%（1727/1764，95%CI 97.1-98.5）和 96.3%（95%CI 95.3-97.1）。简化协议和标准协议的读者间一致性分别为 0.68 和 0.54。简化协议的阅读时间中位数比标准协议缩短了 20%至 30%。
简化协议减少了阅读时间和假阳性，但可能对敏感性产生负面影响。
数字乳腺断层摄影术（DBT）比乳腺摄影术更敏感，在筛查中的采用可能会受到其对放射科医生工作量的潜在影响的限制，即阅读时间增加和疲劳。
与标准协议（切片加平面）相比，简化协议（仅切片）减少了时间和假阳性，但对敏感性产生了负面影响。
