Tomosynthesis in the Diagnostic Setting: Changing Rates of BI-RADS Final Assessment over Time
Purpose To evaluate the effect of tomosynthesis in diagnostic mammography on the Breast Imaging Reporting and Data System (BI-RADS) final assessment categories over time. Materials and Methods This retrospective study was approved by the institutional review board. The authors reviewed all diagnosti...
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Published in | Radiology Vol. 281; no. 1; pp. 54 - 61 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
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01.10.2016
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Abstract | Purpose To evaluate the effect of tomosynthesis in diagnostic mammography on the Breast Imaging Reporting and Data System (BI-RADS) final assessment categories over time. Materials and Methods This retrospective study was approved by the institutional review board. The authors reviewed all diagnostic mammograms obtained during a 12-month interval before (two-dimensional [2D] mammography [June 2, 2010, to June 1, 2011]) and for 3 consecutive years after (tomosynthesis year 1 [2012], tomosynthesis year 2 [2013], and tomosynthesis year 3 [2014]) the implementation of tomosynthesis. The requirement to obtain informed consent was waived. The rates of BI-RADS final assessment categories 1-5 were compared between the 2D and tomosynthesis groups. The positive predictive values after biopsy (PPV3) for BI-RADS category 4 and 5 cases were compared. The mammographic features (masses, architectural distortions, calcifications, focal asymmetries) of lesions categorized as probably benign (BI-RADS category 3) and those for which biopsy was recommended (BI-RADS category 4 or 5) were reviewed. The χ(2) test was used to compare the rates of BI-RADS final assessment categories 1-5 between the two groups, and multivariate logistic regression analysis was performed to compare all diagnostic studies categorized as BI-RADS 3-5. Results There was an increase in the percentage of cases reported as negative or benign (BI-RADS category 1 or 2) with tomosynthesis (58.7% with 2D mammography vs 75.8% with tomosynthesis at year 3, P < .0001). A reduction in the percentage of probably benign (BI-RADS category 3) final assessments also occurred (33.3% with 2D mammography vs 16.4% with tomosynthesis at year 3, P < .0001). Although the rates of BI-RADS 4 or 5 assessments did not change significantly with tomosynthesis (8.0% with 2D mammography vs 7.8% with tomosynthesis at year 3, P = .2), there was a significant increase in the PPV3 (29.6% vs 50%, respectively; P < .0001). These trends increased during the 3 years of tomosynthesis use. Conclusion Tomosynthesis in the diagnostic setting resulted in progressive shifts in the BI-RADS final assessment categories over time, with a significant increase in the proportion of studies classified as normal, a continued decrease in the rate of studies categorized as probably benign, and improved diagnostic confidence in biopsy recommendations. (©) RSNA, 2016. |
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AbstractList | Purpose To evaluate the effect of tomosynthesis in diagnostic mammography on the Breast Imaging Reporting and Data System (BI-RADS) final assessment categories over time. Materials and Methods This retrospective study was approved by the institutional review board. The authors reviewed all diagnostic mammograms obtained during a 12-month interval before (two-dimensional [2D] mammography [June 2, 2010, to June 1, 2011]) and for 3 consecutive years after (tomosynthesis year 1 [2012], tomosynthesis year 2 [2013], and tomosynthesis year 3 [2014]) the implementation of tomosynthesis. The requirement to obtain informed consent was waived. The rates of BI-RADS final assessment categories 1-5 were compared between the 2D and tomosynthesis groups. The positive predictive values after biopsy (PPV3) for BI-RADS category 4 and 5 cases were compared. The mammographic features (masses, architectural distortions, calcifications, focal asymmetries) of lesions categorized as probably benign (BI-RADS category 3) and those for which biopsy was recommended (BI-RADS category 4 or 5) were reviewed. The χ(2) test was used to compare the rates of BI-RADS final assessment categories 1-5 between the two groups, and multivariate logistic regression analysis was performed to compare all diagnostic studies categorized as BI-RADS 3-5. Results There was an increase in the percentage of cases reported as negative or benign (BI-RADS category 1 or 2) with tomosynthesis (58.7% with 2D mammography vs 75.8% with tomosynthesis at year 3, P < .0001). A reduction in the percentage of probably benign (BI-RADS category 3) final assessments also occurred (33.3% with 2D mammography vs 16.4% with tomosynthesis at year 3, P < .0001). Although the rates of BI-RADS 4 or 5 assessments did not change significantly with tomosynthesis (8.0% with 2D mammography vs 7.8% with tomosynthesis at year 3, P = .2), there was a significant increase in the PPV3 (29.6% vs 50%, respectively; P < .0001). These trends increased during the 3 years of tomosynthesis use. Conclusion Tomosynthesis in the diagnostic setting resulted in progressive shifts in the BI-RADS final assessment categories over time, with a significant increase in the proportion of studies classified as normal, a continued decrease in the rate of studies categorized as probably benign, and improved diagnostic confidence in biopsy recommendations. (©) RSNA, 2016. Purpose To evaluate the effect of tomosynthesis in diagnostic mammography on the Breast Imaging Reporting and Data System (BI-RADS) final assessment categories over time. Materials and Methods This retrospective study was approved by the institutional review board. The authors reviewed all diagnostic mammograms obtained during a 12-month interval before (two-dimensional [2D] mammography [June 2, 2010, to June 1, 2011]) and for 3 consecutive years after (tomosynthesis year 1 [2012], tomosynthesis year 2 [2013], and tomosynthesis year 3 [2014]) the implementation of tomosynthesis. The requirement to obtain informed consent was waived. The rates of BI-RADS final assessment categories 1-5 were compared between the 2D and tomosynthesis groups. The positive predictive values after biopsy (PPV3) for BI-RADS category 4 and 5 cases were compared. The mammographic features (masses, architectural distortions, calcifications, focal asymmetries) of lesions categorized as probably benign (BI-RADS category 3) and those for which biopsy was recommended (BI-RADS category 4 or 5) were reviewed. The χ(2) test was used to compare the rates of BI-RADS final assessment categories 1-5 between the two groups, and multivariate logistic regression analysis was performed to compare all diagnostic studies categorized as BI-RADS 3-5. Results There was an increase in the percentage of cases reported as negative or benign (BI-RADS category 1 or 2) with tomosynthesis (58.7% with 2D mammography vs 75.8% with tomosynthesis at year 3, P < .0001). A reduction in the percentage of probably benign (BI-RADS category 3) final assessments also occurred (33.3% with 2D mammography vs 16.4% with tomosynthesis at year 3, P < .0001). Although the rates of BI-RADS 4 or 5 assessments did not change significantly with tomosynthesis (8.0% with 2D mammography vs 7.8% with tomosynthesis at year 3, P = .2), there was a significant increase in the PPV3 (29.6% vs 50%, respectively; P < .0001). These trends increased during the 3 years of tomosynthesis use. Conclusion Tomosynthesis in the diagnostic setting resulted in progressive shifts in the BI-RADS final assessment categories over time, with a significant increase in the proportion of studies classified as normal, a continued decrease in the rate of studies categorized as probably benign, and improved diagnostic confidence in biopsy recommendations. (©) RSNA, 2016. |
Author | Raghu, Madhavi Geisel, Jaime L Forman, Howard P Hooley, Regina J Goehler, Alexander Durand, Melissa A Horvath, Laura J Michalski, Mark H Butler, Reni Andrejeva, Liva Philpotts, Liane E |
Author_xml | – sequence: 1 givenname: Madhavi surname: Raghu fullname: Raghu, Madhavi organization: From the Department of Diagnostic Radiology, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8216 – sequence: 2 givenname: Melissa A surname: Durand fullname: Durand, Melissa A organization: From the Department of Diagnostic Radiology, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8216 – sequence: 3 givenname: Liva surname: Andrejeva fullname: Andrejeva, Liva organization: From the Department of Diagnostic Radiology, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8216 – sequence: 4 givenname: Alexander surname: Goehler fullname: Goehler, Alexander organization: From the Department of Diagnostic Radiology, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8216 – sequence: 5 givenname: Mark H surname: Michalski fullname: Michalski, Mark H organization: From the Department of Diagnostic Radiology, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8216 – sequence: 6 givenname: Jaime L surname: Geisel fullname: Geisel, Jaime L organization: From the Department of Diagnostic Radiology, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8216 – sequence: 7 givenname: Regina J surname: Hooley fullname: Hooley, Regina J organization: From the Department of Diagnostic Radiology, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8216 – sequence: 8 givenname: Laura J surname: Horvath fullname: Horvath, Laura J organization: From the Department of Diagnostic Radiology, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8216 – sequence: 9 givenname: Reni surname: Butler fullname: Butler, Reni organization: From the Department of Diagnostic Radiology, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8216 – sequence: 10 givenname: Howard P surname: Forman fullname: Forman, Howard P organization: From the Department of Diagnostic Radiology, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8216 – sequence: 11 givenname: Liane E surname: Philpotts fullname: Philpotts, Liane E organization: From the Department of Diagnostic Radiology, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8216 |
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SubjectTerms | Adult Aged Aged, 80 and over Breast Neoplasms - diagnostic imaging Female Humans Mammography Middle Aged Predictive Value of Tests Radiographic Image Enhancement - methods Retrospective Studies Sensitivity and Specificity |
Title | Tomosynthesis in the Diagnostic Setting: Changing Rates of BI-RADS Final Assessment over Time |
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