Comparison of Tomosynthesis Plus Digital Mammography and Digital Mammography Alone for Breast Cancer Screening

Abstract

Patients undergoing tomosynthesis plus digital mammography had significantly lower screening recall rates. The greatest reductions were for those younger than 50 years and those with dense breasts. A nonsignificant 9.5% increase in cancer detection was observed in the tomosynthesis group.

The TOMMY trial: a comparison of TOMosynthesis with digital MammographY in the UK NHS Breast Screening Programme – a multicentre retrospective reading study comparing the diagnostic performance of digital breast tomosynthesis and digital mammography with digital mammography alone

“…The improvement in specificity for 2D + DBT compared with 2D alone was observed irrespective of mammographic density, age, tumour size and dominant radiological feature and in both invasive cancers and DCIS, as noted previously, 16,59,60 and indicates the potential of integrated DBT to improve specificity by allowing readers to avoid recalling false negative cases. In agreement with published studies, 17,45,141 ROC analysis demonstrated a significant increase in diagnostic accuracy for 2D + DBT compared with 2D alone and was most likely attributable to the marked improvement in specificity.…”

“…Non-significant increases in cancer detection ranging from 4.3% to 49.0% have been reported in several screening studies after the addition of DBT; 59,60,138,139 in these cases lack of statistical significance was largely attributable to sample size limitations. Our results differ from data from two prospective screening trials comparing 2D + DBT and 2D alone.…”

“…Nevertheless, the inherent selection bias in our study data set could result in an overestimate of the true impact of DBT on specificity. Reductions in recall rate ranging from 15% to 42% 59,60,[138][139][140] have been reported using 2D + DBT in screening compared with 2D alone. The magnitude of the decrease is likely to vary depending on the recall/arbitration policy in practice, background recall rate and reader experience.…”

“…In comparisons between studies, other methodological differences in study design that could confound the interpretation of results should also be noted. Our study, similar to the Oslo 19 and STORM 66 trials, used paired comparisons of 2D and 2D + DBT data from the same cases whereas other studies 59,60,[138][139][140] compared data from different cohorts of women before and after the introduction of 2D + DBT screening. Differences in reading protocol could also impact on the interpretation of results.…”

“…33,44,57 Several studies have shown increased specificity of DBT compared with 2D 16,33,45 and in combination with 2D mammography. 16,20,43,46,58 In a multireader multicentre trial using receiver operating characteristic (ROC) analysis, Rafferty et al 17 reported increased diagnostic accuracy of 2D + DBT compared with 2D alone, particularly in the detection of invasive cancers, and a reduction in the false-positive recall rate and a large retrospective evaluation of screening mammography in 13,158 women 59 reported a significantly lower recall rate with 2D + DBT compared with 2D alone, especially for women aged < 50 years and those with dense breasts. However, the latter study was underpowered to demonstrate any significant increase in cancer detection rate.…”