Early Clinical Experience with Digital Breast Tomosynthesis for Screening Mammography

Durand, Melissa A.; Haas, Brian M.; Yao, Xiaopan; Geisel, Jaime; Raghu, Madhavi; Hooley, Regina J.; Horváth, L.; Philpotts, Liane E.

doi:10.1148/radiol.14131319

Cited by 163 publications

(69 citation statements)

References 18 publications

(27 reference statements)

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“…Digital breast tomosynthesis (DBT) is rapidly being implemented in breast clinics as the "better mammogram" because it addresses some of the limitations of conventional two-dimensional mammography by alleviating the effect of superimposed structures that lead to both false-positive and false-negative results at breast cancer screening (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Strategies to Increase Cancer Detection: Review of True-Positive and False-Negative Results at Digital Breast Tomosynthesis Screening

Korhonen¹,

Weinstein²,

McDonald³

et al. 2016

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Section: Introductionmentioning

confidence: 99%

Strategies to Increase Cancer Detection: Review of True-Positive and False-Negative Results at Digital Breast Tomosynthesis Screening

Korhonen¹,

Weinstein²,

McDonald³

et al. 2016

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“…In the interim, the three-dimensional reconstruction technology of digital breast tomosynthesis was approved by Health Canada (in 2009, but is limited in availability) and by the U.S. Food and Drug Administration [but only as an adjunct to two-dimensional (2D) mammographic imaging] [117][118][119][120] . 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 .…”

Section: New Screening Modalities: Digital Breast Tomosynthesismentioning

confidence: 99%

“…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] . Confirmation in robust clinical trials such as the large randomized t-mist trial (Yaffe MJ, co-investigator) is awaited, although I note that it lacks a control group of unscreened women.…”

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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“…The ability to scroll through the layers of the breast allows better localisation of structures and minimises the impact of overlapping breast tissue associated with two-dimensional (2D) imaging. The combination of DBT combined with DM screening also increases cancer detection, demonstrating improved sensitivity and specificity over DM alone [2, 3, 6, 8–10]. This raises a new clinical question: if DBT screening detects additional cancer, is MRI for the evaluation of extent of disease needed in women with DBT screen-detected cancer?…”

Section: Introductionmentioning

confidence: 99%

Assessment of disease extent on contrast-enhanced MRI in breast cancer detected at digital breast tomosynthesis versus digital mammography alone

et al. 2017

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AIM To compare the utility of breast magnetic resonance imaging (MRI) in determining the extent of disease in patients with newly diagnosed breast cancer detected on combination digital breast tomosynthesis (DBT) versus digital screening mammography (DM). MATERIALS AND METHODS Review of 24,563 DBT-screened patients and 10,751 DM-screened patients was performed. Two hundred and thirty-five DBT patients underwent subsequent MRI examinations; 82 to determine extent of disease after newly diagnosed breast cancer. Eighty-three DM patients underwent subsequent MRI examinations; 23 to determine extent of disease. MRI examinations performed to assess disease extent were considered true positives if additional disease was discovered in the contralateral breast or >2 cm away from the index malignancy. Differences in cancer subtypes and MRI outcomes between the DM and DBT cohorts were compared using chi-squared tests and post-hoc Bonferroni-adjusted tests for equal proportions. RESULTS No differences in cancer subtype findings were observed between the two cohorts; however, MRI outcomes were found to differ between the DBT and DM cohorts (p=0.024). Specifically, the DBT cohort had significantly (p=0.013) fewer true-positive findings (7/82, 8.5%) than did the DM cohort (7/23; 30%), whereas the false-positive rate was similar between the cohorts (not statistically significant). When stratifying by breast density, this difference in true-positive rates was primarily observed when evaluating women with non-dense breasts (p=0.001). CONCLUSION In both the DM- and DBT-screened populations with new cancer diagnoses, MRI is able to detect additional cancer; however, in those patients who have DBT screen-detected cancers the positive impact of preoperative MRI is diminished, particularly in those women with non-dense breasts.

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Early Clinical Experience with Digital Breast Tomosynthesis for Screening Mammography

Abstract: Use of tomosynthesis ( 2D two-dimensional + 3D three-dimensional ) compared with conventional mammography ( 2D two-dimensional ) is associated with a lower recall rate of screening mammography, most often for asymmetries.

Cited by 163 publications

References 18 publications

Strategies to Increase Cancer Detection: Review of True-Positive and False-Negative Results at Digital Breast Tomosynthesis Screening

Strategies to Increase Cancer Detection: Review of True-Positive and False-Negative Results at Digital Breast Tomosynthesis Screening

Beyond the Mammography Debate: A Moderate Perspective

Assessment of disease extent on contrast-enhanced MRI in breast cancer detected at digital breast tomosynthesis versus digital mammography alone

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