Multiple Angulated Mammography Reconstructions in Digital Breast Tomosynthesis for the Diagnosis of Microcalcifications – Added Value to Standard Stack Reconstructions and Synthesized Mammography

Abstract

Purpose To compare ratings regarding the depiction, diagnostic accuracy and lesion characterization of conventional synthesized mammography (SM), multiple angulated mammography reconstructions (INSIGHT3D), and standard stack reconstructions in digital breast tomosynthesis for microcalcifications.

Materials and Methods This is a retrospective, multicase, multireader study. We included patients with digital breast tomosynthesis (DBT), microcalcifications and histology over a period of four months in our institution and the same number of normal cases. Three radiologists, who were blinded to patient data, independently rated the depiction, distribution, morphology and BI-RADS score of microcalcifications in SM, INSIGHT3D and standard stack reconstructions. Deidentified images were presented in random order. Reading time was measured. Friedman and post hoc Nemenyi tests, Cochrane’s Q and post hoc Wilcoxon signed rank tests, Fleiss’ kappa and receiver operating characteristics were used for statistical analysis.

Results We included 41 histopathologically proven and 41 normal cases. Depiction of microcalcifications was rated better in INSIGHT3D than in SM and better in stack reconstructions than in INSIGHT3D and SM (P < 0.001). The reading time was lower in SM and INSIGHT3D compared to stack reconstructions (P < 0.001). The diagnostic accuracy and inter-rater correlation were comparable between all tested modes of reconstruction.

Conclusions INSIGHT3D has higher ratings regarding the depiction of microcalcifications compared to SM while maintaining a short reading time. Our preliminary assessment suggests that INSIGHT3D provides added value to SM.

Key points 

• INSIGHT3D depicts microcalcifications better than synthesized mammography while maintaining a low reading time.

• The diagnostic accuracy and inter-rater correlation were comparable between INSIGHT3D and synthesized mammography.

• INSIGHT3D may be a potential successor to synthesized mammography.

Citation Format

• Neubauer J, Neubauer C, Wicklein J et al. Multiple Angulated Mammography Reconstructions in Digital Breast Tomosynthesis for the Diagnosis of Microcalcifications – Added Value to Standard Stack Reconstructions and Synthesized Mammography. Fortschr Röntgenstr 2018; DOI: 10.1055/s-0044-100726

Zusammenfassung

Zweck Vergleich der Bildqualitätsbewertungen, diagnostischen Genauigkeit und Läsionscharakterisierung von synthetischer Mammografie (SM), mehrfach angulierten Mammografierekonstruktionen (INSIGHT3D) und Standard-Schicht-Rekonstruktionen für Mikroverkalkungen in der digitalen Brust-Tomosynthese.

Materialen und Methoden Dies ist eine retrospektive Multicase-Multireader-Studie. Eingeschlossen wurden Patienten mit digitaler Brust-Tomosynthese (DBT), Mikroverkalkungen und Histologie über einen Zeitraum von vier Monaten in unserer Institution und die gleiche Anzahl von normalen Fällen. Drei verblindete Radiologen beurteilten unabhängig voneinander die Darstellung, Verteilung, Morphologie und den BI-RADS-Score von Mikroverkalkungen in SM, INSIGHT3D und Standard-Schicht-Rekonstruktionen. Die Bilder wurden anonymisiert und in zufälliger Reihenfolge präsentiert. Die Lesezeit wurde gemessen. Friedman und Post-hoc-Nemenyi-Tests, Cochrane’s Q und Post-hoc-Wilcoxon-Vorzeichen-Rang-Tests, Fleiss’-Kappa- und Receiver Operating Characteristics wurden für die statistische Analyse verwendet.

Ergebnisse Wir haben 41 histopathologisch gesicherte und 41 normale Fälle eingeschlossen. Die Erkennbarkeit von Mikroverkalkungen wurde mit INSIGHT3D besser bewertet als mit SM und besser mit den Standard-Schicht-Rekonstruktionen als mit INSIGHT3D und SM (P < 0,001). Die Lesezeit war mit SM und INSIGHT3D im Vergleich zu Standard-Schicht-Rekonstruktionen niedriger (P < 0,001). Die diagnostische Genauigkeit und die Korrelation unter den Beobachtern waren vergleichbar zwischen allen getesteten Rekonstruktionen.

Schlussfolgerungen Im Vergleich zur SM zeigt INSIGHT3D bessere Bewertungen bezüglich der Erkennbarkeit von Mikroverkalkungen, wobei eine kurze Befundungszeit beibehalten wird. Diese erste Untersuchung legt einen Vorteil von INSIGHT3D gegenüber der SM nahe.

Kernaussagen 

• INSIGHT3D stellt Mikroverkalkungen besser dar als die synthetische Mammografie unter Beibehaltung einer kurzen Befundungszeit.

• Die diagnostische Genauigkeit und Inter-Rater-Korrelation waren vergleichbar zwischen INSIGHT3D und synthetischer Mammografie.

• INSIGHT3D könnte die synthetische Mammografie möglicherweise ersetzen.

Key words

synthezised mammography - insight3D - image manipulation/reconstruction - breast - microcalcifications - digital breast tomosynthesis

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