TY - JOUR
T1 - A comparative efficacy study of diagnostic digital breast tomosynthesis and digital mammography in BI-RADS 4 breast cancer diagnosis
AU - Ezeana, Chika F.
AU - Puppala, Mamta
AU - Wang, Lin
AU - Chang, Jenny C.
AU - Wong, Stephen T.C.
N1 - Funding Information:
This work was supported by the following organizations: The National Cancer Institute (NCI) at the National Institutes of Health for Research Grant 1R01CA251710, T.T. & W.F. Chao Foundation, The John S. Dunn Research Foundation, and The Breast Cancer Research Foundation. The foundations and grant-funding agencies had no role in the study’s conception and design, collection, analysis, and interpretation of the data, or writing of this manuscript. The corresponding authors have full access to all the data and reserved rights to share the same. They have the final responsibility to submit the manuscript for its publication.
Funding Information:
The authors would like to thank the following funding support organizations: The National Cancer Institute (NCI) at the National Institutes of Health for Research Grant R01CA251710, T.T. & W.F. Chao Foundation, The John S. Dunn Research Foundation, and The Breast Cancer Research Foundation. The authors would also like to thank Information Technology colleagues at Houston Methodist Hospital, Biostatistics and Bioinformatics Shared Resource colleagues at Houston Methodist Cancer Center, for their help with this project as well as Dr. Rebecca Danforth for proofreading the manuscript.
Funding Information:
The authors would like to thank the following funding support organizations: The National Cancer Institute (NCI) at the National Institutes of Health for Research Grant R01CA251710, T.T. & W.F. Chao Foundation, The John S. Dunn Research Foundation, and The Breast Cancer Research Foundation.
Publisher Copyright:
© 2022
PY - 2022/8
Y1 - 2022/8
N2 - Purpose: Probability of malignancy for BI-RADS 4-designated breast lesions ranges from 2% to 95%, contributing to high false-positive biopsy rates. We compare clinical performance of digital breast tomosynthesis (DBT) versus digital mammography (2D) among our BI-RADS 4 population without prior history of breast cancer. Methods: We extracted retrospective data i.e., clinical, mammogram reports, and biopsy data, from electronic medical records across Houston Methodist's nine hospitals for patients who underwent diagnostic examinations using both modalities (02/01/2015 – 09/30/2020). 2D and DBT cohorts were not intra-individual matched, and there was no direct mammogram evaluation. Using Student's t test, Fisher's exact test, and Chi-squared test, we evaluated the data to determine statistical significance of differences between modalities in BI-RADS 4 cases. We calculated adjusted odds-ratio between modalities for cancer detection rate (CDR) and biopsy-derived positive predictive value (PPV3). Results: There were 6,356 encounters (6,020 patients) in 2D and 5,896 encounters (5,637 patients) in DBT assessed as BI-RADS 4. Using Fisher's exact test, DBT mammography cases were significantly assessed as BI-RADS 4 5.66% more often than those undergoing 2D mammography, P = 0.0046 (1.0566 95% CI: 1.0169–1.0977). The CDRs were 112.65 (2D) and 120.76 (DBT), adjusted odds-ratio: 1.04 (0.93, 1.16)), P = 0.5029, while PPV3 were 14.41% (2D) and 15.99% (DBT), adjusted odds-ratio: 1.09 (0.97, 1.22), P = 0.1483; both logistic regression-adjusted for all other factors. Conclusion: DBT did not achieve better performance and sensitivity in assigning BI-RADS 4 cases compared with 2D, showed no significant advantage in CDR and PPV3, and does not reduce false-positive biopsies among BI-RADS 4-assessed patients.
AB - Purpose: Probability of malignancy for BI-RADS 4-designated breast lesions ranges from 2% to 95%, contributing to high false-positive biopsy rates. We compare clinical performance of digital breast tomosynthesis (DBT) versus digital mammography (2D) among our BI-RADS 4 population without prior history of breast cancer. Methods: We extracted retrospective data i.e., clinical, mammogram reports, and biopsy data, from electronic medical records across Houston Methodist's nine hospitals for patients who underwent diagnostic examinations using both modalities (02/01/2015 – 09/30/2020). 2D and DBT cohorts were not intra-individual matched, and there was no direct mammogram evaluation. Using Student's t test, Fisher's exact test, and Chi-squared test, we evaluated the data to determine statistical significance of differences between modalities in BI-RADS 4 cases. We calculated adjusted odds-ratio between modalities for cancer detection rate (CDR) and biopsy-derived positive predictive value (PPV3). Results: There were 6,356 encounters (6,020 patients) in 2D and 5,896 encounters (5,637 patients) in DBT assessed as BI-RADS 4. Using Fisher's exact test, DBT mammography cases were significantly assessed as BI-RADS 4 5.66% more often than those undergoing 2D mammography, P = 0.0046 (1.0566 95% CI: 1.0169–1.0977). The CDRs were 112.65 (2D) and 120.76 (DBT), adjusted odds-ratio: 1.04 (0.93, 1.16)), P = 0.5029, while PPV3 were 14.41% (2D) and 15.99% (DBT), adjusted odds-ratio: 1.09 (0.97, 1.22), P = 0.1483; both logistic regression-adjusted for all other factors. Conclusion: DBT did not achieve better performance and sensitivity in assigning BI-RADS 4 cases compared with 2D, showed no significant advantage in CDR and PPV3, and does not reduce false-positive biopsies among BI-RADS 4-assessed patients.
KW - BI-RADS4-assessed patients
KW - biopsy-derived positive predictice value
KW - cancer detection rate
KW - digital breast tomosynthesis
KW - digital mammography
KW - false-positive biopsies
KW - Breast Neoplasms/diagnostic imaging
KW - Predictive Value of Tests
KW - Breast/diagnostic imaging
KW - Humans
KW - Mammography
KW - Biopsy
KW - Female
KW - Retrospective Studies
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U2 - 10.1016/j.ejrad.2022.110361
DO - 10.1016/j.ejrad.2022.110361
M3 - Article
C2 - 35617870
AN - SCOPUS:85130612018
SN - 0720-048X
VL - 153
SP - 110361
JO - European Journal of Radiology
JF - European Journal of Radiology
M1 - 110361
ER -