A reader study comparing prospective tomosynthesis interpretations with retrospective readings of the corresponding FFDM examinations.

RATIONALE AND OBJECTIVES: To compare performance of prospective interpretations of clinical tomosynthesis (digital breast tomosynthesis [DBT]) plus full-field digital mammography (FFDM) examinations with retrospective readings of the corresponding FFDM examinations alone. METHODS AND MATERIALS: Seven Mammography Quality Standard Act-qualified radiologists retrospectively interpreted 10,878 FFDM examinations that had been interpreted by other radiologists during prospective clinical interpretations of DBT plus FFDM. The radiologists were blinded to the Breast Imaging Reporting and Data System (BIRADS) category given during the clinical interpretations and the verified outcome by follow-up and/or any diagnostic workup that may have followed. Ratings (BIRADS 0, 1, or 2) were recorded. Group performance levels in terms of recall rates and attributable cancer detection rates were compared to the prospective clinical interpretations of the same examinations (DBT plus FFDM) using McNemar test (two sided/tailed) with significance level of .05. RESULTS: During the prospective clinical interpretations of DBT plus FFDM, 588 cases were recalled (588 of 10,878, 5.41%) compared to 888 cases recalled (888 of 10,878, 8.16%) during the FFDM-alone retrospective interpretations (absolute difference, 35%; P<.0001). There were 59 and 38 suspicious abnormalities later verified as cancers detected during the DBT plus FFDM and the FFDM-alone interpretations, respectively (absolute increase, 55%; P<.0001). Invasive cancer detections were 48 and 29, respectively (absolute increase, 66%; P<.0001). CONCLUSIONS: The combination of DBT plus FFDM for screening asymptomatic women resulted in a significant reduction in recall rates and a simultaneous increase in cancer detection rates when compared to retrospective interpretations of corresponding FFDM examinations alone.

Receiver operating characteristic analysis for the detection of simulated microcalcifications on mammograms using hardcopy images.

The aim of this study was to compare mammography systems based on three different detectors--a conventional screen-film (SF) combination, an a-Si/CsI flat-panel (FP)-based detector, and a charge-coupled device (CCD)-based x-ray phosphor-based detector--for their performance in detecting simulated microcalcifications (MCs). 112-150 microm calcium carbonate grains were used to simulate MCs and were overlapped with a slab phantom of simulated 50% adipose/50% glandular breast tissue-equivalent material referred to as the uniform background. For the tissue structure background, 200-250 microm calcium carbonate grains were used and overlapped with an anthropomorphic breast phantom. All MC phantom images were acquired with and without magnification (1.8 X). The hardcopy images were reviewed by five mammographers. A five-point confidence level rating was used to score each detection task. Receiver operating characteristic (ROC) analysis was performed, and the areas under the ROC curves (A(z)s) were used to compare the performances of the three mammography systems under various conditions. The results showed that, with a uniform background and contact images, the FP-based system performed significantly better than the SF and the CCD-based systems. For magnified images with a uniform background, the SF and the FP-based systems performed equally well and significantly better than the CCD-based system. With tissue structure background and contact images, the SF system performed significantly better than the FP and the CCD-based systems. With magnified images and a tissue structure background, the SF and the CCD-based systems performed equally well and significantly better than the FP-based system. In the detection of MCs in the fibroglandular and the heterogeneously dense regions, no significant differences were found except that the SF system performed significantly better than the CCD-based system in the fibroglandular regions for the contact images.

Specimen radiography in confirmation of MRI-guided needle localization and surgical excision of breast lesions.

OBJECTIVE: Confirmation of lesion retrieval after MRI-guided needle localization and surgical excision of breast lesions are difficult because the targeted lesion is not enhanced ex vivo. The aim of this study was to determine the feasibility of using specimen radiography to verify lesion removal after MRI-guided needle localization and surgical excision. CONCLUSION: To our knowledge, our study was the first to examine the use of specimen radiography in the localization and excision of breast lesions. Specimen radiography is a reliable, cost-effective alternative to repeated dynamic contrast-enhanced MRI for confirming lesion removal after surgery. Specimen radiography has the additional advantage of facilitating immediate assessment of surgical margins.