H Ψηφιακή Τομοσύνθεση Σώζει ζωές

Από πολυκεντρικές μελέτες που πραγματοποιήθηκαν διερευνήθηκε η αποδοτικότητα του συστήματος της Ψηφιακής Τομοσύνθεσης Ηologic Selenia Dimensions 3D και συγκρίθηκε η ικανότητα του ακτινολόγου στην ανίχνευση του καρκίνου με χρήση της 2D ψηφιακής μαστογραφίας σε συνδυασμό με την 3D, συγκριτικά με την χρήση μόνο της κλασικής 2D ψηφιακής μαστογραφίας. Στην Εικόνα 6 φαίνεται η καμπύλη ROC (καμπύλη ευαισθησίας και ειδικότητας) η οποία προέκυψε κατά μέσο όρο από 12 ανεξάρτητες καμπύλες ROC. Η μέση περιοχή κάτω από την καμπύλη ROC αυξήθηκε για τους ιατρούς διαγνώστες από 0.83 σε 0.90 χρησιμοποιώντας μια καταγραφή  BIRADS , σημειώνοντας δηλαδή αύξηση της τάξεως του 0.07, μια ιδιαίτερα σημαντική αύξηση με p-value ίσο με 0.0004. Χρησιμοποιώντας την μέθοδο 2D+3D έναντι της 2D μόνο , βελτιώθηκε η ευαισθησία από 66% σε 76% στις περιπτώσεις καρκίνων  BIRADS 4 και 5. Η ειδικότητα (specificity) σε βλάβες κατηγορίας BIRADS 1-3,  αυξήθηκε από 84% σε 89%. Τέλος, παρατηρήθηκε μία μέση μείωση 43% του ποσοστού επανάκλησης (ψευδώς αρνητικά).

                   

Μόνο ο Ψηφιακός Μαστογράφος Hologic Dimensions 3D 

διαθέτει FDA approval για εξετάσεις ΤΟΜΟΣΥΝΘΕΣΗΣ

RSNA 2011 - Key Scientific Tomosynthesis Presentations

There were several key scientific tomosynthesis presentations given at RSNA 2011 that add to the growing body of support for the benefits of tomosynthesis.  Below are highlights of five of the most relevant presentations.  The RSNA abstract for each is provided in a separate, attached document.

1.            Reading Time of FFDM and Tomosynthesis in a Population-based Screening Program; Skaane P, Gullien R, Eben E, Ekseth U, Haakenaasen U, Jahr G Jebsen I, Krager M;

                RSNA 2011, MSVB31-07 Breast Series: Emerging Technologies in Breast Imaging

               

Overview:          

The Oslo Screening Study will enroll 20K – 25K patients and will be an important study in terms of worldwide clinical acceptance and adoption of tomosynthesis.  Interim results were based on enrollment of 3,356 patients in the first 3 months of the study.  

Key Results and Conclusions:    

·        47% increase in cancer detection using tomosynthesis plus 2D imaging (8 cancers were missed in the FFDM arm and none were missed in the tomosynthesis arm)

·        Interpretation time for tomosynthesis is acceptable for high-volume mode screening

2.            Tomosynthesis During Baseline Examinations: Preliminary Assessment from a Prospective Screening Trial

                Gur D, Sumkin J, Zuley M, Anello M, Catullo V, Chough D, Cohen C, Ganott M, Hakim C, Hoffman W, Shah R, Shinde D

                RSNA 2011, MSVB31-08 Breast Series: Emerging Technologies in Breast Imaging

               

                Overview:

                Analysis of first 120 patients in ongoing, prospective study to evaluate the use of tomosynthesis during baseline screening in subjects between 39 and 56 years of age.  This study will continue, with a projected enrollment of 2,000 subjects.

               

Key Results and Conclusions:

·        28% reduction in recall rate with the use of FFDM plus tomosynthesis compared to FFDM alone

·        The use of tomosynthesis plus FFDM results in a substantial decrease in recall rates during baseline screening mammography of young women

3.            FFDM vs FFDm with Tomosynthesis for Women with Radiographically Dense Breasts: An Enriched Retrospective Reader Study

                Rafferty E, Niklason L

                RSNA 2011, MSVB31-10 Breast Series: Emerging Technologies in Breast Imaging

               

                Overview:

293 cases with BI-RADS density score of 3 or 4 were read retrospectively by 8 radiologists to evaluate the performance of tomosynthesis in dense breasts.

Key Results and Conclusions:

·        10% increase in recall rate for cancer cases with tomosynthesis plus 2D compared to 2D alone

·        31% reduction in recall rate for non-cancer cases with tomosynthesis plus 2D compared to 2D alone

·        Significant gain in diagnostic accuracy (ROC performance) for tomosynthesis plus 2D compared to 2D alone

·        Signficant gain in diagnostic accuracy for non-calcification cases (masses and distortion) for tomosynthesis plus 2D compared to 2D alone

·        Significant gain in  diagnostic accuracy for calcifications for tomosynthesis plus 2D compared to 2D alone

·        The combination of FFDM plus tomosynthesis offers the potential for improved cancer detection and reduced recall rates in women with dense breasts

4.            Digital Breast Tomosynthesis vs Supplemental Diagnostic Mammography Images for the Evaluation of Noncalcified Breast Lesions

                Zuley M, Sumkin J, Ganott M, Bandos A, Kelly A, Lu A, Catullo V, Chough D, Gur D, Perrin R; RSNA 2011, MSVB31-06 Breast Series: Emerging Technologies in Breast Imaging

                Overview:

Retrospective review of diagnostic 2D and tomosynthesis images of 217 accrued lesions to compare diagnostic performance of tomosynthesis to additional diagnostic mammographic views

Key Results and Conclusions:

·        Tomosynthesis has comparable sensitivity and specificity to standard diagnostic additional mammographic views in non-calcified breast lesions

·        Tomosynthesis may be able to replace additional diagnostic mammographic images in the evaluation of patients suspected of having a non-calcified lesion

5.            A Two-fold Dose Reduction in Breast Screening with Tomosynthesis (DBT) through the Use of Reconstructed 2D Images from the DBT Dataset

                Gur D, Zuley M, Lu A, Anello M, Rathfon G, Abrams G, Hakim C, Wallace L, Chough D, Ganott M, Perrin R, Sumkin J

                RSNA 2011, MSVB31-09 Breast Series: Emerging Technologies in Breast Imaging

                Overview:

Retrospective reader study of 114 cases comparing the performance of synthetically reconstructed 2D with tomosynthesis to FFDM with tomosynthesis

                Key Results and Conclusions:

·        Moderately higher sensitivity with same sensitivity seen using true FFDM images compared to synthetically reconstructed 2D images, both combined with tomosynthesis

·        Minor improvement in quality of synthesized 2D images could lead to acceptable diagnostic quality (Note: an older reconstruction algorithm was used for these images; current version is expected to show greatly improved performance)