Diagnostic Performance of Digital versus Film Mammography for Breast-Cancer Screening
Etta D. Pisano, M.D., Constantine Gatsonis, Ph.D., Edward Hendrick, Ph.D., Martin Yaffe, Ph.D., Janet K. Baum, M.D., Suddhasatta Acharyya, Ph.D., Emily F. Conant, M.D., Laurie L. Fajardo, M.D., Lawrence Bassett, M.D., Carl D'Orsi, M.D., Roberta Jong, M.D., Murray Rebner, M.D., for the Digital Mammographic Imaging Screening Trial (DMIST) Investigators Group
Background Film mammography has limited sensitivity for thedetection of breast cancer in women with radiographically densebreasts. We assessed whether the use of digital mammographywould avoid some of these limitations.
Methods A total of 49,528 asymptomatic women presenting forscreening mammography at 33 sites in the United States and Canadaunderwent both digital and film mammography. All relevant informationwas available for 42,760 of these women (86.3 percent). Mammogramswere interpreted independently by two radiologists. Breast-cancerstatus was ascertained on the basis of a breast biopsy donewithin 15 months after study entry or a follow-up mammogramobtained at least 10 months after study entry. Receiver-operating-characteristic(ROC) analysis was used to evaluate the results.
Results In the entire population, the diagnostic accuracy ofdigital and film mammography was similar (difference betweenmethods in the area under the ROC curve, 0.03; 95 percent confidenceinterval, –0.02 to 0.08; P=0.18). However, the accuracyof digital mammography was significantly higher than that offilm mammography among women under the age of 50 years (differencein the area under the curve, 0.15; 95 percent confidence interval,0.05 to 0.25; P=0.002), women with heterogeneously dense orextremely dense breasts on mammography (difference, 0.11; 95percent confidence interval, 0.04 to 0.18; P=0.003), and premenopausalor perimenopausal women (difference, 0.15; 95 percent confidenceinterval, 0.05 to 0.24; P=0.002).
Conclusions The overall diagnostic accuracy of digital and filmmammography as a means of screening for breast cancer is similar,but digital mammography is more accurate in women under theage of 50 years, women with radiographically dense breasts,and premenopausal or perimenopausal women. (ClinicalTrials.govnumber, NCT00008346
[ClinicalTrials.gov]
.)
Source Information
From the Departments of Radiology and Biomedical Engineering, the Biomedical Research Imaging Center, and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (E.D.P.); the Center for Statistical Sciences, Brown University, Providence, R.I. (C.G., S.A.); the Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago (E.H.); the Departments of Medical Imaging (M.Y., R.J.) and Medical Biophysics (M.Y.), University of Toronto, Toronto; the Department of Radiology, Beth Israel Deaconess Medical Center, Boston (J.K.B.); the Department of Radiology, University of Pennsylvania Medical School, Philadelphia (E.F.C.); the Department of Radiology, University of Iowa, Iowa City (L.L.F.); the Department of Radiology, University of California at Los Angeles, Los Angeles (L.B.); the Department of Radiology, Emory University, Atlanta (C.D.); and the Department of Radiology, William Beaumont Hospital, Royal Oak, Mich. (M.R.). This article was published at www.nejm.org on September 16, 2005.
Address reprint requests to Dr. Pisano at etta_pisano{at}med.unc.edu.
Digital and Film Mammography
Crystal P., Strano S., Keen J. D., Ebell M. H., Gatsonis C., Pisano E. D., Hendrick E.
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N Engl J Med 2006;
354:765-767, Feb 16, 2006.
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A correction has been published: N Engl J Med 2006;355(17):1840.
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