Digital Mammography versus Breast Tomosynthesis: Impact of Breast Density on Diagnostic Performance in Population-based Screening.

BackgroundPrevious studies comparing digital breast tomosynthesis (DBT) to digital mammography (DM) have shown conflicting results regarding breast density and diagnostic performance.PurposeTo compare true-positive and false-positive interpretations in DM versus DBT according to volumetric density, age, and mammographic findings.Materials and MethodsFrom November 2010 to December 2012, 24 301 women aged 50-69 years (mean age, 59.1 years ± 5.7) were prospectively included in the Oslo Tomosynthesis Screening Trial. Participants received same-compression DM and DBT with independent double reading for both DM and DM plus DBT reading modes. Eight experienced radiologists rated the images by using a five-point scale for probability of malignancy. Participants were followed up for 2 years to assess for interval cancers. Breast density was assessed by using automatic volumetric software (scale, 1-4). Differences in true-positive rates, false-positive rates, and mammographic findings were assessed by using confidence intervals (Newcombe paired method) and P values (McNemar and χ2 tests).ResultsThe true-positive rate of DBT was higher than that of DM for density groups (range, 12%-24%; P < .001 for density scores of 2 and 3, and P > .05 for density scores of 1 and 4) and age groups (range, 15%-35%; P < .05 for all age groups), mainly due to the higher number of spiculated masses and architectural distortions found at DBT (P < .001 for density scores of 2 and 3; P < .05 for women aged 55-69 years). The false-positive rate was lower for DBT than for DM in all age groups (range, -0.6% to -1.2%; P < .01) and density groups (range, -0.7 to -1.0%; P < .005) owing to fewer asymmetric densities (P ≤ .001), except for extremely dense breasts (0.1%, P = .82).ConclusionDigital breast tomosynthesis enabled the detection of more cancers in all density and age groups compared with digital mammography, especially cancers classified as spiculated masses and architectural distortions. The improvement in cancer detection rate showed a positive correlation with age. With use of digital breast tomosynthesis, false-positive findings were lower due to fewer asymmetric densities, except in extremely dense breasts.© RSNA, 2019Online supplemental material is available for this article.See also the editorial by Fuchsjäger and Adelsmayr in this issue.