Comparison of digital mammography and digital breast tomosynthesis in the detection of architectural distortion

Objectives To compare interobserver variability (IOV), reader confidence, and sensitivity/specificity in detecting architectural distortion (AD) on digital mammography (DM) versus digital breast tomosynthesis (DBT). Methods This IRB-approved, HIPAA-compliant reader study used a counterbalanced experimental design. We searched radiology reports for AD on screening mammograms from 5 March 2012–27 November 2013. Cases were consensus-reviewed. Controls were selected from demographically matched non-AD examinations. Two radiologists and two fellows blinded to outcomes independently reviewed images from two patient groups in two sessions. Readers recorded presence/absence of AD and confidence level. Agreement and differences in confidence and sensitivity/specificity between DBT versus DM and attendings versus fellows were examined using weighted Kappa and generalised mixed modeling, respectively. Results There were 59 AD patients and 59 controls for 1,888 observations (59 × 2 (cases and controls) × 2 breasts × 2 imaging techniques × 4 readers). For all readers, agreement improved with DBT versus DM (0.61 vs. 0.37). Confidence was higher with DBT, p = .001. DBT achieved higher sensitivity (.59 vs. .32), p .90). DBT achieved higher positive likelihood ratio values, smaller negative likelihood ratio values, and larger ROC values. Conclusions DBT decreases IOV, increases confidence, and improves sensitivity while maintaining high specificity in detecting AD. Key points • Digital breast tomosynthesis decreases interobserver variability in the detection of architectural distortion . • Digital breast tomosynthesis increases reader confidence in the detection of architectural distortion . • Digital breast tomosynthesis improves sensitivity in the detection of architectural distortion .