Breast cancer screening using tomosynthesis in combination with digital mammography compared to digital mammography alone: a cohort study within the PROSPR consortium

Abstract

Purpose Digital breast tomosynthesis (DBT) is emerging as the new standard of care for breast cancer screening based on improved cancer detection coupled with reductions in recall compared to screening with digital mammography (DM) alone. However, many prior studies lack follow-up data to assess false negatives examinations. The purpose of this study is to assess if DBT is associated with improved screening outcomes based on follow-up data from tumor registries or pathology. Methods Retrospective analysis of prospective cohort data from three research centers performing DBT screening in the PROSPR consortium from 2011–2014 was performed. Recall and biopsy rates were assessed from 198,881 women age 40–74 years undergoing screening (142,883 DM and 55,998 DBT examinations). Cancer, cancer detection, and false negative rates and positive predictive values were assessed on examinations with one year of follow-up. Logistic regression was used to compare DBT to DM adjusting for research center, age, prior breast imaging, and breast density. Results There was a reduction in recall with DBT compared to DM (8.7% vs. 10.4%, p<0.0001), with adjusted OR=0.68 (95% CI=0.65–0.71). DBT demonstrated a statistically significant increase in cancer detection over DM (5.9 vs. 4.4/1,000 screened, adjusted OR=1.45, 95% CI=1.12–1.88), an improvement in PPV1 (6.4% for DBT vs. 4.1% for DM, adjusted OR=2.02, 95% CI=1.54–2.65), and no significant difference in false negative rates for DBT compared to DM (0.46 vs. 0.60/1,000 screened, p=0.347). Conclusions Our data support implementation of DBT screening based on increased cancer detection, reduced recall, and no difference in false negative screening examinations.

Added Value of Digital Breast Tomosynthesis Combined with Digital Mammography According to Reader Agreement: Changes in BI-RADS Rate and Follow-Up Management

“…Our study confirmed the results obtained in previous studies [5,25,26]; there was an increase in both true-negative and true-positive cases with DM+DBT compared to DM alone.…”

“…More cases were also classified BI-RADS category 4 and 5 with DBT+DM (about 13% more than with DM alone), which means higher cancer detection rates, consistent with the results of prior studies [29,30]. There was also a significant reduction in false-positive and false-negative cases as also previously reported in the literature [20,25]. The work-up rate was significantly reduced with DBT+DM versus DM alone (33-42%), similar to previous studies in analogue settings (38.5% for 1-view tomosynthesis [24]).…”

Implementation of Synthesized Two-dimensional Mammography in a Population-based Digital Breast Tomosynthesis Screening Program

“…DBT imaging was added to the practice in September 2011. Our institution previously published results that compared the digital mammography/DBT group with 10 728 patients from a digital mammographyonly screening population (2,3,(16)(17)(18)(19).…”

Breast Cancer Screening: Updated Recommendations of the Brazilian College of Radiology and Diagnostic Imaging, Brazilian Breast Disease Society, and Brazilian Federation of Gynecological and Obstetrical Associations

“…Other studies corroborated these findings. 43,44 Some points are yet to be discussed regarding the tomosynthesis protocol. The Food and Drug Administration recommends a combined approach (combo mode) to breast cancer screening, in which conventional digital mammography views (mediolateral-oblique and cranial-caudal) are combined with tomosynthesis acquisition in those same two planes.…”