Mammographic Surveillance After Breast-Conserving Therapy: Impact of Digital Breast Tomosynthesis and Artificial Intelligence-Based Computer-Aided Detection.

Abstract

<b>BACKGROUND.</b> Postoperative mammograms present interpretive challenges due to postoperative distortion and hematomas. The application of digital breast tomosyn-thesis (DBT) and artificial intelligence-based computer-aided detection (AI-CAD) after breast-conserving therapy (BCT) has not been widely investigated. <b>OBJECTIVE.</b> The purpose of our study was to assess the impact of additional DBT or AI-CAD on recall rate and diagnostic performance in women undergoing mammographic surveillance after BCT. <b>METHODS.</b> This retrospective study included 314 women (mean age, 53.3 ± 10.6 [SD] years; four with bilateral breast cancer) who underwent BCT followed by DBT (mean interval from surgery to DBT, 15.2 ± 15.4 months). Three breast radiologists independently reviewed images in three sessions: digital mammography (DM), DM with DBT (DM plus DBT), and DM with AI-CAD (DM plus AI-CAD). Recall rates and diagnostic performance were compared between DM, DM plus DBT, and DM plus AI-CAD using the readers' mean results. <b>RESULTS.</b> Of the 314 women, six breast recurrences (three ipsilateral and three contralateral) had developed at the time of surveillance mammography. The ipsilateral breast recall rate was lower for DM plus AI-CAD (1.9%) than for DM (11.2%) or DM plus DBT (4.1%) (<i>p</i> < .001). The contralateral breast recall rate was significantly lower for DM plus AI-CAD (1.5%, <i>p</i> < .001) than for DM (6.6%) but for not DM plus DBT (2.7%, <i>p</i> = .08). In the ipsilateral breast, accuracy was higher for DM plus AI-CAD (97.0%) than for DM (88.5%) or DM plus DBT (94.8%) (<i>p</i> < .05); specificity was higher for DM plus AI-CAD (98.3%) than for DM (89.3%) or DM plus DBT (96.1%) (<i>p</i> < .05); sensitivity was significantly lower for DM plus AI-CAD (22.2%) than for DM (66.7%, <i>p</i> = .03) but not DM plus DBT (22.2%, <i>p</i> > .99). In the contralateral breast, accuracy was significantly higher for DM plus AI-CAD (97.1%) than for DM (92.5%, <i>p</i> < .001) but not DM plus DBT (96.1%, <i>p</i> = .25); specificity was significantly higher for DM plus AI-CAD (98.6%) than for DM (93.7%, <i>p</i> < .001) but not DM plus DBT (97.5%) (<i>p</i> = .09); sensitivity was not different between DM (33.3%), DM plus DBT (22.2%), and DM plus AI-CAD (11.1%) (<i>p</i> > .05). <b>CONCLUSION.</b> After BCT, adjunct DBT or AI-CAD reduced recall rates and improved accuracy in the ipsilateral and contralateral breasts compared with DM. In the ipsilateral breast, the addition of AI-CAD resulted in a lower recall rate and higher accuracy than the addition of DBT. <b>CLINICAL IMPACT.</b> AI-CAD may help address the challenges of interpreting post-BCT surveillance mammograms.