Diagnostic performance of tomosynthesis and breast ultrasonography in women with dense breasts: a prospective comparison study
Authors
Won Hwa Kim ; Jung Min Chang ; Joongyub Lee ; A Jung Chu ; Mirinae Seo ; Hye Mi Gweon ; Hye Ryoung Koo ; Su Hyun Lee ; Nariya Cho ; Min Sun Bae ; Sung Ui Shin ; Sung Eun Song ; Woo Kyung Moon
Citation
BREAST CANCER RESEARCH AND TREATMENT, Vol.162(1) : 85-94, 2017-02
Adult ; Area Under Curve ; Breast Density* ; Breast Neoplasms / diagnostic imaging* ; Breast Neoplasms / pathology* ; Female ; Follow-Up Studies ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional* / methods ; Middle Aged ; Prospective Studies ; Reproducibility of Results ; Sensitivity and Specificity ; Ultrasonography, Mammary* / methods ; Workflow
Keywords
Breast neoplasm ; Diagnostic performance ; Mammographic density ; Tomosynthesis ; Ultrasonography
Abstract
Purpose: To compare the diagnostic performances of tomosynthesis and ultrasonography as adjunctives to digital mammography in women with dense breasts.
Methods: A total of 778 women with dense breasts underwent digital mammography with tomosynthesis and ultrasonography for screening and diagnostic purposes. The findings of tomosynthesis and ultrasonography were evaluated independently. The primary endpoint was overall diagnostic accuracy determined by area under the receiver operating characteristic curve (AUC). Secondary endpoints included sensitivity, specificity, and predictive values.
Results: Of the 778 participants, 698 women (140 breast cancers) were included in the analysis. Based on the AUC findings, the non-inferiority of tomosynthesis to ultrasonography was established in the overall group as well as in all subgroups except for that comprising women with extremely dense breast composition. There were no significant differences in AUC between tomosynthesis and ultrasonography among asymptomatic participants and participants who underwent imaging for screening (0.912 vs. 0.934 [P = 0.403] and 0.987 vs. 0.950 [P = 0.270], respectively). Tomosynthesis exhibited lower sensitivity (91.4 vs. 96.4%; P = 0.039), and higher specificity (83.9 vs. 70.4%; P < 0.001) and positive predictive value (58.7 vs. 45.0%; P < 0.001) than ultrasonography.
Conclusions: Tomosynthesis exhibits comparable performance to ultrasonography as an adjunct to mammography for diagnosis of breast cancer, except among women with extremely dense breasts.