Digital Breast Tomosynthesis with Synthesized Two-Dimensional Images versus Full-Field Digital Mammography for Population Screening: Outcomes from the Verona Screening Program

Abstract

Purpose To examine the outcomes of a breast cancer screening program based on digital breast tomosynthesis (DBT) plus synthesized two-dimensional (2D) mammography compared with those after full-field digital mammography (FFDM). Materials and Methods This prospective study included 16 666 asymptomatic women aged 50-69 years who were recruited in April 2015 through March 2016 for DBT plus synthetic 2D screening in the Verona screening program. A comparison cohort of women screened with FFDM (n = 14 423) in the previous year was included. Screening detection measures for the two groups were compared by calculating the proportions associated with each outcome, and the relative rates (RRs) were estimated with multivariate logistic regression. Results Cancer detection rate (CDR) for DBT plus synthetic 2D imaging was 9.30 per 1000 screening examinations versus 5.41 per 1000 screening examinations with FFDM (RR, 1.72; 95% confidence interval [CI]: 1.30, 2.29). CDR was significantly higher in patients screened with DBT plus synthetic 2D imaging than in those screened with FFDM among women classified as having low breast density (RR, 1.53; 95% CI: 1.13, 2.10) or high breast density (RR, 2.86; 95% CI: 1.42, 6.25). The positive predictive value (PPV) for recall was almost doubled with DBT plus synthetic 2D imaging: 23.3% versus 12.9% of recalled patients who were screened with FFDM (RR, 1.81; 95% CI: 1.34, 2.47). The recall rate was similar between groups (RR, 0.95; 95% CI: 0.84, 1.06), whereas the recall rate with invasive assessment was higher for DBT plus synthetic 2D imaging than for FFDM (RR, 1.93; 95% CI: 1.31, 2.03). The mean number of screening studies interpreted per hour was significantly lower for screening examinations performed with DBT plus synthetic 2D imaging (38.5 screens per hour) than with FFDM (60 screens per hour) (P < .001). Conclusion DBT plus synthetic 2D imaging increases CDRs with recall rates comparable to those of FFDM. DBT plus synthetic 2D imaging increased image reading time and the time needed for invasive assessments. RSNA, 2017.

Comparison between software volumetric breast density estimates in breast tomosynthesis and digital mammography images in a large public screening cohort

“…However, breast cancer screening is going through major changes and recent technical developments have produced imaging methods that are more sensitive than digital mammography (DM), of which digital breast tomosynthesis (BT), a pseudo 3D mammographic technique, is the most promising in a screening setting, being fast, accessible and accurate [1–5]. …”

“…Modern breast cancer diagnostics are reliant on early cancer detection, which has led to an implementation of public breast cancer-screening programmes with mammography in many developed countries. However, breast cancer screening is going through major changes and recent technical developments have produced imaging methods that are more sensitive than digital mammography (DM), of which digital breast tomosynthesis (BT), a pseudo 3D mammographic technique, is the most promising in a screening setting, being fast, accessible and accurate [ 1 – 5 ].…”

Digital breast tomosynthesis plus synthesised images versus standard full-field digital mammography in population-based screening (TOSYMA): protocol of a randomised controlled trial

“…Increased cancer detection rates were present among women classified as having low breast density or high breast density. 19 …”

Is Tomosynthesis the Future of Breast Cancer Screening?

“…T his issue of Radiology features a retrospective review from Caumo and colleagues comparing participant outcomes before and after the introduction of tomosynthesis in a breast cancer screening program (1). It adds to the literature that shows that screening programs implementing various versions of the newer technology achieve higher breast cancer detection rates (2)(3)(4)(5)(6).…”

“…The discussion section describes very well the limitations of studies like this and how the screening programs in Italy and the United States differ (1). The preponderance of prior publications assess the performance characteristics of only the Hologic (Marlborough, Mass) system, which utilizes TM plus digital mammography (DM).…”