Diagnostic impact of digital tomosynthesis in oncologic patients with suspected pulmonary lesions on chest radiography

Objectives To assess the actual diagnostic impact of digital tomosynthesis (DTS) in oncologic patients with suspected pulmonary lesions on chest radiography (CXR). Methods A total of 237 patients (135 male, 102 female; age, 70.8±10.4 years) with a known primary malignancy and suspected pulmonary lesion(s) on CXR and who underwent DTS were retrospectively identified. Two radiologists (experience, 10 and 15 years) analysed in consensus CXR and DTS images and proposed a diagnosis according to a confidence score: 1 or 2=definitely or probably benign pulmonary or extrapulmonary lesion, or pseudolesion; 3=indeterminate; 4 or 5=probably or definitely pulmonary lesion. DTS findings were proven by CT (n=114 patients), CXR during follow-up (n=105) or histology (n=18). Results Final diagnoses included 77 pulmonary opacities, 26 pulmonary scars, 12 pleural lesions and 122 pulmonary pseudolesions. DTS vs CXR presented a higher (P<0.05) sensitivity (92 vs 15 %), specificity (91 vs 9 %), overall accuracy (92 vs 12 %), and diagnostic confidence (area under ROC, 0.997 vs 0.619). Mean effective dose of CXR vs DTS was 0.06 vs 0.107 mSv (P<0.05). Conclusions DTS improved diagnostic accuracy and confidence in comparison to CXR alone in oncologic patients with suspected pulmonary lesions on CXR with only a slight, though significant, increase in radiation dose.