Comparison of lesion detection and conspicuity between narrow-angle and wide-angle digital breast tomosynthesis for dense and non-dense breasts

Digital breast tomosynthesis (DBT) has been shown to improve both sensitivity and specificity for breast cancer detection compared to full-field digital mammography. However, its performance could be limited for patients with dense breasts. Clinical DBT systems vary in their system designs, one of which is the acquisition angular range (AR), which leads to varied performance for different imaging tasks. In this study, we aim to compare DBT systems with different AR. We used a previously validated cascaded linear system model to investigate the dependence of in-plane breast structural noise (BSN) and detectability of masses on AR. We conducted a pilot clinical study to compare the lesion conspicuity between clinical DBT systems with the narrowest and the widest AR. Patients called back for diagnostic imaging on suspicious findings were imaged with both narrow-angle (NA) and wide-angle (WA) DBT. We analyzed the BSN for clinical images using noise power spectrum (NPS) analysis. A 5-point Likert scale was used in the reader study to compare the lesion conspicuity. Our theoretical calculation results show that increasing AR leads to reduced BSN and improved mass detectability. The NPS analysis on clinical images shows the lowest BSN for WA DBT. The WA DBT provides better lesion conspicuity for masses and asymmetries and shows a greater advantage for non-microcalcification lesions in dense breasts. The NA DBT provides better characterizations for microcalcifications. The WA DBT can downgrade false-positive findings seen on NA DBT. In conclusion, WA DBT could improve the detection of masses and asymmetries for patients with dense breasts.