European Radiology

, Volume 29, Issue 2, pp 477–484 | Cite as

Comparison of performance metrics with digital 2D versus tomosynthesis mammography in the diagnostic setting

  • Manisha BahlEmail author
  • Sarah Mercaldo
  • Charmi A. Vijapura
  • Anne Marie McCarthy
  • Constance D. Lehman



To compare performance metrics between digital 2D mammography (DM) and digital breast tomosynthesis (DBT) in the diagnostic setting.


Consecutive diagnostic examinations from August 2008 to February 2011 (DM group) and from January 2013 to July 2015 (DM/DBT group) were reviewed. Core biopsy and surgical pathology results within 365 days after the mammogram were collected. Performance metrics, including cancer detection rate (CDR), abnormal interpretation rate (AIR), positive predictive value (PPV) 2, PPV3, sensitivity, and specificity were calculated. Multivariable logistic regression models were fit to compare performance metrics in the DM and DM/DBT groups while adjusting for clinical covariates.


A total of 22,883 mammograms were performed before DBT integration (DM group), and 22,824 mammograms were performed after complete DBT integration (DM/DBT group). After adjusting for multiple variables, the CDR was similar in both groups (38.2 per 1,000 examinations in the DM/DBT group versus 31.3 per 1,000 examinations in the DM group, p = 0.14); however, a higher proportion of cancers were invasive rather than in situ in the DM/DBT group [83.7% (731/873) versus 72.3% (518/716), p < 0.01]. The AIR was lower in the DM/DBT group (p < 0.01), and PPV2, PPV3, and specificity were higher in the DM/DBT group (all p = 0.01 or p < 0.01).


Complete integration of DBT into the diagnostic setting is associated with improved diagnostic performance. Increased utilization of DBT may thus result in better patient outcomes and lead to a shift in the benchmarks that have been established for DM.

Key Points

• Integration of tomosynthesis into the diagnostic setting is associated with improved performance.

• A higher proportion of cancers are invasive rather than in situ with digital breast tomosynthesis.

• Increased utilization of tomosynthesis may lead to a shift in established benchmarks.


Benchmark Breast cancer Breast carcinoma in situ Digital breast tomosynthesis Digital mammography 



Abnormal interpretation rate


Breast Cancer Surveillance Consortium


Breast Imaging Reporting and Data System


Cancer detection rate


Digital breast tomosynthesis


Digital 2D mammography


Positive predictive value



This study was presented as an electronic poster at the 2017 Society of Breast Imaging (SBI)/American College of Radiology (ACR) Breast Imaging Symposium.


The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Manisha Bahl, MD, MPH.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Constance D. Lehman, MD, PhD, has a research grant from GE Healthcare and serves on an advisory board for GE Healthcare. The authors of this manuscript declare no other relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Sarah Mercaldo, PhD) has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• observational

• performed at one institution


  1. 1.
    Hooley RJ, Durand MA, Philpotts LE (2017) Advances in digital breast tomosynthesis. AJR Am J Roentgenol 208(2):256–266CrossRefGoogle Scholar
  2. 2.
    Ciatto S, Houssami N, Bernardi D et al (2013) Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study. Lancet Oncol 14(7):583–589CrossRefGoogle Scholar
  3. 3.
    Skaane P, Bandos AI, Gullien R et al (2013) Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology 267(1):47–56CrossRefGoogle Scholar
  4. 4.
    Friedewald SM, Rafferty EA, Rose SL et al (2014) Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA 311(24):2499–2507CrossRefGoogle Scholar
  5. 5.
    McCarthy AM, Kontos D, Synnestvedt M et al (2014) Screening outcomes following implementation of digital breast tomosynthesis in a general-population screening program. J Natl Cancer Inst 106(11)Google Scholar
  6. 6.
    Sharpe RE Jr, Venkataraman S, Phillips J et al (2016) Increased cancer detection rate and variations in the recall rate resulting from implementation of 3D digital breast tomosynthesis into a population-based screening program. Radiology 278(3):698–706CrossRefGoogle Scholar
  7. 7.
    Raghu M, Durand MA, Andrejeva L et al (2016) Tomosynthesis in the diagnostic setting: changing rates of BI-RADS final assessment over time. Radiology 281(1):54–61CrossRefGoogle Scholar
  8. 8.
    Sickles EA, D'Orsi CJ, Bassett LW et al (2013) ACR BI-RADS mammography. In: ACR BI-RADS atlas, breast imaging reporting and data system. American College of Radiology, Reston, VAGoogle Scholar
  9. 9.
    Rose SL, Tidwell AL, Bujnoch LJ, Kushwaha AC, Nordmann AS, Sexton R Jr (2013) Implementation of breast tomosynthesis in a routine screening practice: an observational study. AJR Am J Roentgenol 200(6):1401–1408CrossRefGoogle Scholar
  10. 10.
    Bahl M, Gaffney S, McCarthy AM, Lowry KP, Dang PA, Lehman CD (2017) Breast cancer characteristics associated with 2D digital mammography versus digital breast tomosynthesis for screening-detected and interval cancers. Radiology 287(1):49–57CrossRefGoogle Scholar
  11. 11.
    Sprague BL, Arao RF, Miglioretti DL et al (2017) National performance benchmarks for modern diagnostic digital mammography: update from the Breast Cancer Surveillance Consortium. Radiology 283(1):59–69CrossRefGoogle Scholar
  12. 12.
    Bahl M, Lamb LR, Lehman CD (2017) Pathologic outcomes of architectural distortion on digital 2D versus tomosynthesis mammography. AJR Am J Roentgenol 209(5):1162–1167CrossRefGoogle Scholar
  13. 13.
    Poplack SP, Tosteson TD, Kogel CA, Nagy HM (2007) Digital breast tomosynthesis: initial experience in 98 women with abnormal digital screening mammography. AJR Am J Roentgenol 189(3):616–623CrossRefGoogle Scholar
  14. 14.
    Gennaro G, Toledano A, di Maggio C et al (2010) Digital breast tomosynthesis versus digital mammography: a clinical performance study. Eur Radiol 20(7):1545–1553CrossRefGoogle Scholar
  15. 15.
    Hakim CM, Chough DM, Ganott MA, Sumkin JH, Zuley ML, Gur D (2010) Digital breast tomosynthesis in the diagnostic environment: a subjective side-by-side review. AJR Am J Roentgenol 195(2):W172–W176CrossRefGoogle Scholar
  16. 16.
    Noroozian M, Hadjiiski L, Rahnama-Moghadam S et al (2012) Digital breast tomosynthesis is comparable to mammographic spot views for mass characterization. Radiology 262(1):61–68CrossRefGoogle Scholar
  17. 17.
    Tagliafico A, Astengo D, Cavagnetto F et al (2012) One-to-one comparison between digital spot compression view and digital breast tomosynthesis. Eur Radiol 22(3):539–544CrossRefGoogle Scholar
  18. 18.
    Brandt KR, Craig DA, Hoskins TL et al (2013) Can digital breast tomosynthesis replace conventional diagnostic mammography views for screening recalls without calcifications? A comparison study in a simulated clinical setting. AJR Am J Roentgenol 200(2):291–298CrossRefGoogle Scholar
  19. 19.
    Waldherr C, Cerny P, Altermatt HJ et al (2013) Value of one-view breast tomosynthesis versus two-view mammography in diagnostic workup of women with clinical signs and symptoms and in women recalled from screening. AJR Am J Roentgenol 200(1):226–231CrossRefGoogle Scholar
  20. 20.
    Zuley ML, Bandos AI, Ganott MA et al (2013) Digital breast tomosynthesis versus supplemental diagnostic mammographic views for evaluation of noncalcified breast lesions. Radiology 266(1):89–95CrossRefGoogle Scholar
  21. 21.
    Lei J, Yang P, Zhang L, Wang Y, Yang K (2014) Diagnostic accuracy of digital breast tomosynthesis versus digital mammography for benign and malignant lesions in breasts: a meta-analysis. Eur Radiol 24(3):595–602CrossRefGoogle Scholar
  22. 22.
    Peppard HR, Nicholson BE, Rochman CM, Merchant JK, Mayo RC 3rd, Harvey JA (2015) Digital breast tomosynthesis in the diagnostic setting: indications and clinical applications. Radiographics 35(4):975–990CrossRefGoogle Scholar
  23. 23.
    Poplack S (2017) Breast tomosynthesis: clinical evidence. Radiol Clin North Am 55(3):475–492CrossRefGoogle Scholar
  24. 24.
    Spangler ML, Zuley ML, Sumkin JH et al (2011) Detection and classification of calcifications on digital breast tomosynthesis and 2D digital mammography: a comparison. AJR Am J Roentgenol 196(2):320–324CrossRefGoogle Scholar
  25. 25.
    Svahn TM, Houssami N, Sechopoulos I, Mattsson S (2015) Review of radiation dose estimates in digital breast tomosynthesis relative to those in two-view full-field digital mammography. Breast 24(2):93–99CrossRefGoogle Scholar
  26. 26.
    Gennaro G, Bernardi D, Houssami N (2018) Radiation dose with digital breast tomosynthesis compared to digital mammography: per-view analysis. Eur Radiol 28(2):573–581CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Division of Breast Imaging/Department of RadiologyMassachusetts General HospitalBostonUSA
  2. 2.Department of RadiologyMassachusetts General HospitalBostonUSA
  3. 3.Department of MedicineMassachusetts General HospitalBostonUSA

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