Conspicuity of breast cancer according to histopathological type and breast density when imaged by full-field digital mammography compared with screen-film mammography

To compare the conspicuity of different histopathological types of breast cancer according to breast density and mammographic imaging in patients with screen-detected breast cancers undergoing both full-field digital mammography (FFDM) and screen-film mammography (SFM) in the United Kingdom National Health Service Breast Screening Programme (NHSBSP). 185 patients underwent routine screening with SFM followed by further imaging using FFDM with consequent diagnosis of breast cancer. All SFM and soft-copy FFDM images were evaluated by two readers in an independent, retrospective review. The visualisation and conspicuity of the mammographic abnormality were recorded and graded using a four-level scale. Conspicuity of breast cancer was qualitatively evaluated. Breast density and conspicuity were correlated with histopathological diagnosis and inter-observer correlation was calculated. Mixed Model ANOVA demonstrated significant differences between FFDM and SFM (p < 0.001) and breast densities (p = 0.009): conspicuity of the mammographic abnormality (p < 0.001) and visualisation of the dominant mammographic feature (p < 0.001) were significantly greater with FFDM than SFM. This held true for both readers and for all histopathological tumour types with no significant differences between each tumour type. FFDM is significantly superior to SFM for conspicuity of screen-detected breast cancers for all histopathological types and breast densities. (orig.)