Valeur diagnostique de la mammographie synthétique sans et avec tomosynthèse

Purpose: To compare the diagnostic performance of two dimensional synthetic mammography (Synt2DMG) with and without digital breast tomosynthesis (DBT) versus 2D mammography (2DMG) to diagnose breast cancer.Materials and methods: Our institutional ethics committees approved the study and granted a waiver of informed consent. One hundred and two women (mean age 52.8 years, range 28-96 years) who systematically underwent 2DMG and Synt2DMG with DBT and subsequent percutaneous biopsy were analyzed. Three radiologists, with respectively 5 years, 30 years, and 1 year of experience in breast imaging, retrospectively and independently reviewed exams in independent 3 steps: 2DMG, Synt2DMG without DBT and Synt2DMG with DBT. The lesions in the cohort included 32.4% (33/102) cancers and 67.6% (69/102) others lesions. A receiver operating characteristic (ROC) curve analysis was performed to compare the results of the three readings.Results: Calculated by averaging the curves from the 3 readers, the mean area under the ROC (AUC) for BIRADSSynt2DMG+DBT (AUC=0.878 [95% Confidence Interval [CI]: 0.836, 0.913] was higher than that calculated for BIRADS2DMG (AUC=0.829 [95% CI: 0.782, 0.869]) (p=0.005) and for BIRADSSynt2DMG (AUC=0.831 [95% CI: 0.784, 0.871]) (p=0.005). Whatever the reader considered, there was no significant difference between the AUC for BIRADS2DMG and that for BIRADSSynt2DMG (p=0.18, p=0.31 and p=0.23 for reader 1, 2 and 3 respectively). The proportion of cancers undiagnosed by 2DMG and Synt2DMG that were well diagnosed by using synthetic mammography with DBT was 18.2% (6/33) and 12.1% (4/33), 0/33 and 1/33, 12.1% (4/33) and 6.1% (2/33) for readers 1, 2, and 3 respectively. All these lesions were ductal invasive cancer whatever the reader considered.Conclusion: Synt2DMG with DBT is more accurate than Synt2DMG without DBT or 2DMG. Further larger studies are needed to confirm the absence of difference between Synt2DMG and 2DMG. ; Objectifs : Comparer les performances diagnostiques des mammographies synthétiques ...