Digital breast tomosynthesis and ultrasonography: diagnostic performance and effect on recall rates versus digital mammography in category O

The purpose of this study was to compare diagnostic performance and screening recall rates of digital breast tomosynthesis (DBT) and ultrasound (US) added to digital mammography (DM) in the category O. This study was approved by the local ethics committee and informed consent was obtained. The additional breast US and DBT performed 216 women categorized as BI-RADS category O according to screening DM between January 2014 and February 2015. A total of 22 women that previously underwent breast surgery, radiotherapy, chemotherapy were excluded. Finally 194 patients were enrolled in this study. The DM+DBT images and DM+DBT images with US images of patients were independently reviewed by three breast radiologists and than recategorized according to BI-RADS category. Among 194 lesions, 165 (85%) were benign and 29 (14.9%) were malign. DBT reduced recall rate by 70%. For DBT, sensitivity, specificity, PPV, NPV and diagnostic accuracy were 97%, 82%, 48%, 99%, and 84%, whereas for US sensitivity, specificity, PPV, NPV and diagnostic accuracy were 93%, 79%, 47%, 98%, and 81%, respectively. AUC value was 0.89 and 0.86 for DBT and US. In conclusion, DBT reduced recall rates. DBT showed better diagnostic performance than breast US for category O. Reduction in RR was independent from breast parenchymal patterns.