Detection and characterization of breast lesions in a selective diagnostic population: diagnostic accuracy study for comparison between one-view digital breast tomosynthesis and two-view full-field digital mammography.

Objective: To compare the performance of one-view digital breast tomosynthesis (DBT) and two-view full-field digital mammography (FFDM) in the detection and characterization of breast lesions in a selective diagnostic population. Methods: A total of 598 breasts of 319 diagnostic patients were prospectively enrolled. Participants underwent bilateral one-view, mediolateral oblique (MLO) DBT and two-view, craniocaudal and MLO FFDM. The sensitivity and specificity of these methods and their classification into correct Breast Imaging-Reporting and Data System (BI-RADS) categories were compared. These methods were also compared in patients subgrouped by mammographic parenchymal density. Receiver operating characteristic (ROC) curve analysis was performed using the probability of cancer scores. Results: DBT had higher overall sensitivity than FFDM (88.7% vs 80.7%, p - 0.001). Subgroup analyses showed that DBT had significantly higher sensitivity in assessing dense breasts and invasive cancers than FFDM. The BI-RADS category assessment was significantly better for DBT than for FFDM. The differences between the two modalities in specificity (94.1% and 93.2% for FFDM and DBT) were not significant (p = 0.664). The area under the ROC curves using the probability of cancer scores were 0.93 [95% confidence interval (Ci), 0.91-0.95] for FFDM and 0.96 (95% Cl, 0.94-0.97) for DBT (p = 0.005). ROC curve analysis indicated that most of the increased performance of DBT was due to dense breasts. Conclusion: A beneficial effect on the detection and characterization of breast lesions was found for one-view DBT compared with two-view FFDM in a selective diagnostic population. Improvements were especially enhanced in females with dense breasts. These results need to be examined in studies using large-scale consecutive sampling of a diagnostic population. Advances in knowledge: In this study, using selective diagnostic study cases, one-view DBT offered improved reader performance compared with two-view FFDM for detection and characterization of breast cancers. [ABSTRACT FROM AUTHOR]