Rationale and Objective To assess the interaction between the availability of prior examinations and digital breast tomosynthesis (DBT) in decisions to recall a woman during interpretation of mammograms. Materials and Methods Eight radiologists independently interpreted twice 36 mammography examinations, each of which had current and prior full field digital mammography images (FFDM) and DBT under a HIPPA compliant IRB approved protocol (written consent waived). During the first reading three sequential ratings were provided using FFDM only followed by FFDM+ DBT followed by FFDM+DBT+priors. The second reading included FFDM only, then FFDM+priors, then FFDM+priors+DBT. Twenty two benign cases clinically recalled, 12 negative/benign examinations (not recalled) and two verified cancer cases were included. Recall recommendations and interaction between the effect of priors and DBT on decisions were assessed (p=0.05 significance level) using generalized linear model (proc glimmix, SAS. V.9.3., Cary, NC) accounting for case and reader variability. Results Average recall rates in non-cancer cases were significantly reduced (51%; p<0.001) with the addition of DBT and with addition of priors (23%; p=0.01). In absolute terms, the addition of DBT to FFDM reduced the recall rates from 0.67 to 0.42 and from 0.54 to 0.27 when DBT was available before and after priors, respectively. Recall reductions were from 0.64 to 0.54 and from 0.42 to 0.33 when priors were available before and after DBT, respectively. Regardless of the sequence in presentation, there were no statistically significant interactions between the effect of availability of DBT and priors (p=0.80). Conclusion Availability of both priors and DBT are independent, primary factors in reducing recall recommendations during mammographic interpretations.
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