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Clinical Comparison of Full-Field Digital Mammography and Screen-Film Mammography for Detection of Breast Cancer

John M. Lewin1, Carl J. D'Orsi2, R. Edward Hendrick1,3, Lawrence J. Moss2, Pamela K. Isaacs1, Andrew Karellas2 and Gary R. Cutter4

1 University of Colorado Health Sciences Center, 4200 E. 9th Ave., Mail Stop F724, Denver, CO 80262.
2 University of Massachusetts Medical Center, 55 Lake Ave. N., Worcester, MA 01655.
3 Northwestern University Medical School, 357 E. Chicago Ave., Chicago, IL 60611.
4 AMC Cancer Research Center, 1600 Pierce St., Lakewood, CO 80232.



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  		Fig. 1A. —Fortuitous positioning causing recall on screen-film mammography but not on full-field digital mammography. Spot compression images performed for further evaluation of screen-film finding in 45-year-old woman showed no abnormality. Screen-film mediolateral oblique image shows apparent density (arrow).

 


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  		Fig. 1B. —Fortuitous positioning causing recall on screen-film mammography but not on full-field digital mammography. Spot compression images performed for further evaluation of screen-film finding in 45-year-old woman showed no abnormality. Digital mediolateral oblique image shows that density is due to overlapping tissue.

 


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  		Fig. 2A. —Invasive ductal carcinoma in 57-year-old woman detected on full-field digital mammography but not on screen-film mammography. Full-field digital mammogram shows irregular mass (arrow) with sharp, angular margins.

 


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  		Fig. 2B. —Invasive ductal carcinoma in 57-year-old woman detected on full-field digital mammography but not on screen-film mammography. On screen-film mammogram, cancer (arrow) is visible but appearance is similar to that of surrounding foci of normal tissue. Difference in appearance was thought to be primarily caused by difference in projection of cancer after breast compression.

 


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  		Fig. 3A. —Radial scar containing invasive ductal carcinoma and ductal carcinoma in situ detected in 55-year-old woman on screen-film mammography but not on full-field digital mammography. On screen-film mammogram, lesion (arrow) fortuitously projects over pectoral muscle, causing lesion to appear dense and making it more conspicuous.

 


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  		Fig. 3B. —Radial scar containing invasive ductal carcinoma and ductal carcinoma in situ detected in 55-year-old woman on screen-film mammography but not on full-field digital mammography. On full-field digital mammogram, lesion (arrow) straddles pectoral muscle, resulting in low-density center and less conspicuity. Fine spiculations characteristic of radial scar are well shown by both techniques.

 


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  		Fig. 4A. —Ductal carcinoma in situ in 53-year-old woman detected on screen-film mammography but not on full-field digital mammography because of interpretation difference between reviewers. Cancer was occult on mediolateral oblique images from both techniques. On screen-film mammogram, density at lateral aspect of craniocaudal image was unchanged from multiple prior studies. New indentation in contour of this density, which was of concern as possible architectural distortion, led to recall.

 


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  		Fig. 4B. —Ductal carcinoma in situ in 53-year-old woman detected on screen-film mammography but not on full-field digital mammography because of interpretation difference between reviewers. Cancer was occult on mediolateral oblique images from both techniques. On digital craniocaudal mammogram, appearance of density and indentation (arrow) is essentially identical to appearance on screen-film.

 


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  		Fig. 5. —Free-response receiver operating characteristic (ROC) curves for screen-film mammography ({square}, dotted line) and full-field digital mammography ({diamondsuit}, solid line) based on rating scale of 0-100. Scale for x-axis is probability of false-positive finding occurring on two screening images of given breast and is analogous to false-positive rate in standard ROC experiment. Area under screen-film curve is 0.80; area under digital curve is 0.74. Difference is not statistically significant (p = 0.18).

 

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