DIGITAL BREAST TOMOSYNTHESIS IN ONE OR TWO VIEWS AS A REPLACEMENT OR ADJUNCT TECHNIQUE TO FULL-FIELD DIGITAL MAMMOGRAPHY

Clinical studies using different imaging protocols to perform digital breast tomosynthesis (DBT) were reviewed (2008-14) to assess interpretive accuracy. Descriptive pooled statistics were used to estimate and summarise accuracy measures for each type of imaging protocol in relation to that of two-view full-field digital mammography (FFDM). In studies comparing multiple DBT imaging protocols, a trend of increased performance was often seen when including both the mediolateral oblique and craniocaudal views for DBT alone and even more so for DBT adjunct to FFDM. Overall, the average Delta AUC (%; sd) across studies for stand-alone DBT (relative to FFDM), in one and in two views, were 2.2 (+/- 3.7) and 5.9 (+/- 4.6), and when used together with FFDM, 3.9 (+/- 2.0) and 6.7 (+/- 0.9). With respect to individual studies, improvements in accuracy using DBT were present for different types of imaging protocols although the magnitude of the impact varied between studies, and some studies did not show significant improvements in comparison with FFDM. The most consistent effect of improvement in breast cancer detection was seen across studies for two-view DBT with FFDM. These summary findings may depend on the sampling constraints present in tomosynthesis imaging and on other factors discussed in this paper. In order to investigate these effects more thoroughly and how they might impact outcomes, comparative or randomized-controlled trials are warranted.