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Comparison of Calcification Specificity in Digital Mammography Using Soft-Copy Display Versus Screen-Film Mammography

¹ Department of Radiology, University of Ulsan, Asan Medical Center, 388-1, Seoul 138-736, South Korea.
² Department of Radiology and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 27599.
³ Salix Pharmaceuticals, Inc., Morrisville, North Carolina.
⁴ Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
⁵ Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

OBJECTIVE. The purpose of this study was to compare specificity in the interpretation of calcifications in soft-copy reviewing of digital mammograms versus hard-copy reviewing of screen-film mammograms.

MATERIALS AND METHODS. A total of 130 consecutive cases with calcifications (44 malignant and 86 benign) that had been evaluated with needle or surgical biopsy were collected. Both screen-film mammography and soft-copy digital mammography were obtained in the same patients under existing research protocols using Fischer Imaging's SenoScan (n = 71), Lorad's digital mammography system (n = 35), and GE Healthcare's Senographe 2000D (n = 24). Eight trained radiologists scored all lesions—cropped or masked to display just the region of interest—both on screen-film and soft-copy digital mammography with a month between reviews to reduce the effects of learning and memory. A 5-point malignancy scale was used, with 1 as definitely not, 2 as probably not, 3 as possibly, 4 as probably, and 5 as definitely. Reviewers were randomly assigned condition order, and images within each condition were randomly ordered. Repeated measures analysis of variance was used to test for differences between conditions in specificity computed via nonparametric receiver operating characteristic (ROC) study separately for each reviewer and condition.

RESULTS. Across all reviewers, the mean specificity for 1 or 2 versus 3, 4, or 5 was 0.803 for screen-film mammography (range, 0.413-0.938; SD ± 0.166) and 0.833 for soft-copy image (range, 0.375-0.951; SD ± 0.187). Although not statistically significant (Student's t test p values from 0.19 to 0.99 across all cut points), numeric values of specificity were consistently higher for soft-copy versus screen-film mammography. No statistical significance in specificity was seen using all possible cut points in the 5-point scale, although the primary analysis used the cutpoint for differentiation between benign and malignant cases as 1 or 2 versus 3, 4, or 5.

CONCLUSION. No statistically significant difference was shown in specificity achievable using soft-copy digital versus screen-film mammography in this study.

Keywords: breast • comparative studies • diagnostic radiology • digital images • mammography • observer performance

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