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Proceedings Paper

Pursuing optimal thresholds to recommend breast biopsy by quantifying the value of tomosynthesis
Author(s): Yirong Wu; Oguzhan Alagoz; David J. Vanness; Amy Trentham-Dietz; Elizabeth S. Burnside
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Paper Abstract

A 2% threshold has been traditionally used to recommend breast biopsy in mammography. We aim to characterize how the biopsy threshold varies to achieve the maximum expected utility (MEU) of tomosynthesis for breast cancer diagnosis. A cohort of 312 patients, imaged with standard full field digital mammography (FFDM) and digital breast tomosynthesis (DBT), was selected for a reader study. Fifteen readers interpreted each patient’s images and estimated the probability of malignancy using two modes: FFDM versus FFDM + DBT. We generated receiver operator characteristic (ROC) curves with the probabilities for all readers combined. We found that FFDM+DBT provided improved accuracy and MEU compared with FFDM alone. When DBT was included in the diagnosis along with FFDM, the optimal biopsy threshold increased to 2.7% as compared with the 2% threshold for FFDM alone. While understanding the optimal threshold from a decision analytic standpoint will not help physicians improve their performance without additional guidance (e.g. decision support to reinforce this threshold), the discovery of this level does demonstrate the potential clinical improvements attainable with DBT. Specifically, DBT has the potential to lead to substantial improvements in breast cancer diagnosis since it could reduce the number of patients recommended for biopsy while preserving the maximal expected utility.

Paper Details

Date Published: 11 March 2014
PDF: 8 pages
Proc. SPIE 9037, Medical Imaging 2014: Image Perception, Observer Performance, and Technology Assessment, 90370U (11 March 2014); doi: 10.1117/12.2042905
Show Author Affiliations
Yirong Wu, Univ. of Wisconsin-Madison (United States)
Oguzhan Alagoz, Univ. of Wisconsin-Madison (United States)
David J. Vanness, Univ. of Wisconsin-Madison (United States)
Amy Trentham-Dietz, Univ. of Wisconsin-Madison (United States)
Elizabeth S. Burnside, Univ. of Wisconsin-Madison (United States)

Published in SPIE Proceedings Vol. 9037:
Medical Imaging 2014: Image Perception, Observer Performance, and Technology Assessment
Claudia R. Mello-Thoms; Matthew A. Kupinski, Editor(s)

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