Two-View Tomosynthesis Improves Diagnostic Accuracy

Adding two-view tomosynthesis to conventional digital mammography (DM) improves diagnostic accuracy and reduces the recall rate even more than does one-view tomosynthesis, according to a study published in the American Journal of Roentgenology.

Researchers from Massachusetts General Hospital in Boston compared two methods of combining tomosynthesis with digital mammography by assessing diagnostic accuracy and recall rates for digital mammography alone and digital mammography combined with one-view tomosynthesis and two-view tomosynthesis.

A total of 310 cases were included in the study, including 51 biopsy-proven malignancies, 47 biopsy-proven benign findings, 138 recalled screening cases, and 74 negative screening cases. Fifteen radiologists reviewed the cases sequentially using digital mammography, and adding one-view tomosynthesis, and then two-view tomosynthesis.

After the cases were assessed for recall, each was assigned a BI-RADS score and probability of malignancy for each imaging method. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) analysis. Screening recall rates were compared using pooled logistical regression analysis.

The researchers found that the average noncancer recall rate for DM was 44.2 percent; for DM plus one-view tomosynthesis, 27.2 percent; and for DM plus two-view tomosynthesis, 24.0 percent. Both one-view and two-view tomosynthesis combined with DM showed significantly lower noncancer recall rates than DM alone, the researchers noted. In addition, the two-view tomosynthesis was had a significantly lower recall rate than the one-view tomosynthesis.

Diagnostic accuracy for nondense breasts improved with DM plus two-view tomosynthesis compared with digital mammography alone. Compared with digital mammography, diagnostic sensitivity for invasive cancers increased with the addition of both one-view and two- tomosynthesis.

The researchers concluded that adding one-view tomosynthesis to conventional DM improved both diagnostic accuracy and recall rate, but adding two-view tomosynthesis provided twice the performance gain in diagnostic accuracy while further reducing the recall rate.