The differential diagnostic value of digital breast tomosynthesis in combination with synthesized two-dimensional images in breast disease

Objective: To investigate the diagnostic value and characteristics of breast lesion in digital breast tomosynthesis (DBT) in combination with synthesized two-dimensional (2D) images. Methods: The prospective study enrolled women older than 18 years with clinically suspected breast lesion. One hundred and sixty seven patients with 177 lesions confirmed by biopsy or surgery were included. All the patients underwent full-field digital mammography (FFDM) and DBT examinations, and synthesized 2D images (V-preview) were reconstructed from DBT. The images of FFDM, V-preview images and DBT plus FFDM, V-preview images were analyzed. The breast imaging reporting and data system (BI-RADS) and characteristic for predicting benign and malignant lesion were also evaluated. The average glandular dose for a single mammographic view between FFDM and DBT was recorded. The Nonparametric Z test was used to compare the differences among four different mammographic images in BI-RADS. The differential diagnostic-performance among different mammography was evaluated by ROC analysis. Independent t test was used to compare the average glandular dose between FFDM and DBT. Results: One hundred three benign lesions and 74 malignant lesions were confirmed. Compared with FFDM images alone or plus DBT, the diagnostic values of V-preview images alone/or plus DBT were not significantly different(Z = 0.187 and 0.226, P = 0.851 and 0.821), but compared with V-preview, the diagnostic values of V-preview images plus DBT revealed significant difference (Z = 3.546, P < 0.01). The area under ROC for V-preview plus DBT were 0.899, and the sensitivity, specificity, and accuracy were 90.5%, 89.3%, and 89.3%, separately. For the average glandular dose, there was no significant difference between FFDM (1.48 ± 0.52) mGy and DBT (1.56 ± 0.39) mGy examination (t = 1.714, P = 0.087). Conclusion: Synthesized 2D images from DBT, which may eliminate the need for FFDM, in combination with DBT can improve the diagnostic efficiency. (authors)