Pursuing optimal thresholds to recommend breast biopsy by quantifying the value of tomosynthesis

Yirong Wu, Oguzhan Alagoz, David Vanness, Amy Trentham-Dietz, Elizabeth S. Burnside

Research output: Chapter in Book/Report/Conference proceedingConference contribution

3 Scopus citations

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.

Original languageEnglish (US)
Title of host publicationMedical Imaging 2014
Subtitle of host publicationImage Perception, Observer Performance, and Technology Assessment
PublisherSPIE
ISBN (Print)9780819498304
DOIs
Publication statusPublished - Jan 1 2014
EventMedical Imaging 2014: Image Perception, Observer Performance, and Technology Assessment - San Diego, CA, United States
Duration: Feb 16 2014Feb 17 2014

Publication series

NameProgress in Biomedical Optics and Imaging - Proceedings of SPIE
Volume9037
ISSN (Print)1605-7422

Conference

ConferenceMedical Imaging 2014: Image Perception, Observer Performance, and Technology Assessment
CountryUnited States
CitySan Diego, CA
Period2/16/142/17/14

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All Science Journal Classification (ASJC) codes

  • Electronic, Optical and Magnetic Materials
  • Biomaterials
  • Atomic and Molecular Physics, and Optics
  • Radiology Nuclear Medicine and imaging

Cite this

Wu, Y., Alagoz, O., Vanness, D., Trentham-Dietz, A., & Burnside, E. S. (2014). Pursuing optimal thresholds to recommend breast biopsy by quantifying the value of tomosynthesis. In Medical Imaging 2014: Image Perception, Observer Performance, and Technology Assessment [90370U] (Progress in Biomedical Optics and Imaging - Proceedings of SPIE; Vol. 9037). SPIE. https://doi.org/10.1117/12.2042905