Changes in Recall Type and Patient Treatment Following Implementation of Screening Digital Breast Tomosynthesis

Lourenço, Ana P.; Barry-Brooks, Marilyn; Baird, Grayson L.; Tuttle, Ashley; Mainiero, Martha B.

doi:10.1148/radiol.14140317

Cited by 134 publications

(74 citation statements)

References 25 publications

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“…Though it is prudent to use a somewhat lower threshold, the benefits – both for the healthcare system and for patient comfort and compliance – would still be considerable. A reduction of recalls by almost 40% is similar to the most optimistic clinical appraisals of the effect of breast tomosynthesis screening [15, 16, 21, 22]. MI could be used alongside breast tomosynthesis as well as mammography, though the effects need to be investigated.…”

Section: Discussionsupporting

confidence: 57%

“…Three prospective studies – STORM [14], OTST [18] and MBTST [23] – have shown superior cancer detection. Concerning recall rates, the prospective studies show an increase, while the retrospective studies generally show a decrease [15–17, 19–22]. Spectral mammography is another alternative, with a recent study demonstrating its ability to distinguish between cystic and solid lesions [24].…”

Section: Introductionmentioning

confidence: 99%

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Can mechanical imaging increase the specificity of mammography screening?

et al. 2017

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ObjectivesThis study aimed to investigate the effects of adding adjunct mechanical imaging to mammography breast screening. We hypothesized that mechanical imaging could detect increased local pressure caused by both malignant and benign breast lesions and that a pressure threshold for malignancy could be established. The impact of this on breast screening was investigated with regard to reductions in recall and biopsy rates.Methods155 women recalled from breast screening were included in the study, which was approved by the regional ethical review board (dnr 2013/620). Mechanical imaging readings were acquired of the symptomatic breast. The relative mean pressure on the suspicious area (RMPA) was defined and a threshold for malignancy was established.ResultsBiopsy-proven invasive cancers had a median RMPA of 3.0 (interquartile range (IQR) = 3.7), significantly different from biopsy-proven benign at 1.3 (IQR = 1.0) and non-biopsied cases at 1.0 (IQR = 1.3) (P < 0.001). The lowest RMPA for invasive cancer was 1.4, with 23 biopsy-proven benign and 33 non-biopsied cases being below this limit. Had these women not been recalled, recall rates would have been reduced by 36% and biopsy rates by 32%.ConclusionsIf implemented in a screening situation, this may substantially lower the number of false positives.Key Points• Mechanical imaging is used as an adjunct to mammography in breast screening. • A threshold pressure can be established for malignant breast cancer. • Recalls and biopsies can be substantially reduced.

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Section: Discussionsupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Can mechanical imaging increase the specificity of mammography screening?

et al. 2017

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“…30 While it is important to note that our survey participants are not fully aware of the potential benefits, potential risks, and additional costs of these newer technologies, our survey shows that better detection of breast cancer and fewer unnecessary recalls is what women seek. 4,21-24, [31][32][33][34][35] This study has several limitations. The findings may underrepresent patients who do not access healthcare services, have not received a recommendation for a mammogram from a healthcare professional, do not speak English or Spanish, or have limited access to the internet or telephone, among other reasons.…”

Section: Discussionmentioning

confidence: 99%

Listening to Women: Expectations and Experiences in Breast Imaging

Harvey

Gallagher

Nolan

et al. 2015

Journal of Women's Health

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“…One appeal is the reduction of false-positives (approximately 15%) and increased cancer detection rates (approximately 28%; for invasive cancers, 40% or more) [121][122][123] , together with a onethird reduction in recall rates and consequent false-positive biopsies 117,124,125 , especially in younger women and women with dense breasts in whom mammography is limited, and with no negative effect on sensitivity 123,[126][127][128] , which could potentially tip the risk:benefit ratio toward tomosynthesis 129,130 . And although compared with mammography alone, tomosynthesis roughly doubles total radiation exposure, this can be obviated using the synthesized 2D images created from the three-dimensional tomosynthesis dataset, dramatically reducing the radiation (43% or more) to that of a standard mammogram (eliminating separate 2D exposures), with superior lesion visualization for microcalcification cluster detectability [131][132][133][134][135] , and having the potential to render conventional 2D mammography obsolete 117,123,[135][136][137][138][139][140] .…”

Section: New Screening Modalities: Digital Breast Tomosynthesismentioning

confidence: 99%

Beyond the Mammography Debate: A Moderate Perspective

Kaniklidis¹

2015

Current Oncology

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After some decades of contention, one can almost despair and conclude that (paraphrasing) "the mammography debate you will have with you always." Against that sentiment, in this review I argue, after reflecting on some of the major themes of this long-standing debate, that we must begin to move beyond the narrow borders of claim and counterclaim to seek consensus on what the balance of methodologically sound and critically appraised evidence demonstrates, and also to find overlooked underlying convergences; after acknowledging the reality of some residual and non-trivial harms from mammography, to promote effective strategies for harm mitigation; and to encourage deployment of new screening modalities that will render many of the issues and concerns in the debate obsolete.To these ends, I provide a sketch of what this looking forward and beyond the current debate might look like, leveraging advantages from abbreviated breast magnetic resonance imaging technologies (such as the ultrafast and twist protocols) and from digital breast tomosynthesis-also known as three-dimensional mammography. I also locate the debate within the broader context of mammography in the real world as it plays out not for the disputants, but for the stakeholders themselves: the screening-eligible patients and the physicians in the front lines who are charged with enabling both the acts of screening and the facts of screening at their maximally objective and patientaccessible levels to facilitate informed decisions. Key Words REFLECTIONS ON SOME CENTRAL THEMESAll screening programmes do harm; some do good as well, and, of these, some do more good than harm at reasonable cost.-Sir Muir Grey, former director of the U.K. National Screening Committee 1 Some Issues Deserving More AttentionSeveral core issues require closer examination:1. The potential benefits of mammographic screening independent of whether ultimate survival is affected, including diagnosis at earlier stages, typically with smaller tumours and node negativity; reduced likelihood of aggressive treatments and morbidities; detection of high-risk lesions (most diagnosed in the screened group 2 ) allowing for chemoprevention or magnetic resonance imaging (mri) surveillance against occult malignancies, or both; and avoidance of compromised quality of life after diagnosis of advanced disease It is not clear, as often assumed, that survival is the best (or only) measure for judging mammographic screening 2,3 . And it remains open whether claimed harms truly are disproportionate to benefits when using, for instance, a more nuanced definition of overdetection than simply breast cancer (bca) diagnosed but not bca expired (distinguishing, for example, longer recurrence-free survival from simple overall survival benefit).

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Changes in Recall Type and Patient Treatment Following Implementation of Screening Digital Breast Tomosynthesis

Abstract: With DBT, the recall rate decreased and the biopsy PPV and cancer detection rate did not decrease. The distribution of recalled abnormalities changed, and more patients were evaluated with US only.

Cited by 134 publications

References 25 publications

Can mechanical imaging increase the specificity of mammography screening?

Can mechanical imaging increase the specificity of mammography screening?

Listening to Women: Expectations and Experiences in Breast Imaging

Beyond the Mammography Debate: A Moderate Perspective

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