Assessment of Radiologist Performance in Breast Cancer Screening Using Digital Breast Tomosynthesis vs Digital Mammography

Abstract

IMPORTANCE Many US radiologists have screening mammography recall rates above the expertrecommended threshold of 12%. The influence of digital breast tomosynthesis (DBT) on the distribution of radiologist recall rates is uncertain. OBJECTIVE To evaluate radiologists' recall and cancer detection rates before and after beginning interpretation of DBT examinations. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 198 radiologists from 104 radiology facilities in the Breast Cancer Surveillance Consortium who interpreted 251 384 DBT and 2 000 681 digital mammography (DM) screening examinations from 2009 to 2017, including 126 radiologists (63.6%) who interpreted DBT examinations during the study period and 72 (36.4%) who exclusively interpreted DM examinations (to adjust for secular trends). Data were analyzed from April 2018 to July 2019. EXPOSURES Digital breast tomosynthesis and DM screening examinations. MAIN OUTCOMES AND MEASURES Recall rate and cancer detection rate. RESULTS A total of 198 radiologists interpreted 2 252 065 DM and DBT examinations (2 000 681 [88.8%] DM examinations; 251 384 [11.2%] DBT examinations; 710 934 patients [31.6%] aged 50-59 years; 1 448 981 [64.3%] non-Hispanic white). Among the 126 radiologists (63.6%) who interpreted DBT examinations, 83 (65.9%) had unadjusted DM recall rates of no more than 12% before using DBT, with a median (interquartile range) recall rate of 10.0% (7.5%-13.0%). On DBT examinations, 96 (76.2%) had an unadjusted recall rate of no more than 12%, with a median (interquartile range) recall rate of 8.8% (6.3%-11.3%). A secular trend in recall rate was observed, with the multivariableadjusted risk of recall on screening examinations declining by 1.2% (95% CI, 0.9%-1.5%) per year. After adjusting for examination characteristics and secular trends, recall rates were 15% lower on DBT examinations compared with DM examinations interpreted before DBT use (relative risk, 0.85; 95% CI, 0.83-0.87). Adjusted recall rates were significantly lower on DBT examinations compared with DM examinations interpreted before DBT use for 45 radiologists (35.7%) and significantly higher for 18 (14.3%); 63 (50.0%) had no statistically significant change. The unadjusted cancer detection rate on DBT was 5.3 per 1000 examinations (95% CI, 5.0-5.7 per 1000 examinations) compared with 4.7 per 1000 examinations (95% CI, 4.6-4.8 per 1000 examinations) on DM examinations interpreted before DM use (multivariable-adjusted risk ratio, 1.21; 95% CI, 1.11-1.33). CONCLUSIONS AND RELEVANCE In this study, DBT was associated with an overall decrease in recall rate and an increase in cancer detection rate. However, our results indicated that there is wide variability among radiologists, including a subset of radiologists who experienced increased recall (continued) Key Points Question Is digital breast tomosynthesis (DBT) associated with improved radiologist-level breast cancer screening performance? Findings In this cohort study of 198 radiologists from 104 radiology facilities in the Breast Canc...

Comparative Access to and Use of Digital Breast Tomosynthesis Screening by Women’s Race/Ethnicity and Socioeconomic Status

“… 12 , 15 Persistent differences in DBT use between Black and White women may suggest a widening of cancer screening disparities, because DBT is associated with improved outcomes in terms of both improved cancer detection and lower false-positive rates for some subgroups of women. 1 , 8 , 9 , 11 , 29 , 30 …”

“…Routine breast cancer screening with digital breast tomosynthesis (DBT, or 3-dimensional mammography) may improve screening outcomes over traditional digital mammography (DM, or 2-dimensional mammography). 1 , 2 , 3 Multiple prospective trials and observational studies 4 , 5 , 6 , 7 , 8 , 9 demonstrate that DBT can improve the cancer detection rate while decreasing the recall rate from screening compared with DM screening at the population level depending on women’s age, breast density, and screening interval. Since its approval by the US Food and Drug Administration in 2011, DBT has become available in more than two-thirds of all US mammography screening facilities.…”

One view or two views for wide-angle tomosynthesis with synthetic mammography in the assessment setting?

“…The addition of two-view DBT to two-view DM allows for a significant increase in lesion detection rate [6,[21][22][23][24], but results in a relevant increase in radiation exposure [8,9]. The availability of SM eliminates the need to acquire DM, consequently reducing the radiation exposure, while maintaining a detection rate comparable to that of two-view DM with DBT [6,19,25].…”

Breast Health

“…Digital breast tomosynthesis takes images from several angles of the breast to create a three-dimensional (3D) image. Tomosynthesis has been shown to improve cancer detection rates with improved detection of small cancers and to reduce false-positive screening recalls [45]. Tomosynthesis is done in conjunction with a 2D mammogram, increasing radiation exposure.…”