Implementation of Breast Tomosynthesis in a Routine Screening Practice: An Observational Study

Abstract

The introduction of breast tomosynthesis into our practice was associated with a significant reduction in recall rates and a simultaneous increase in breast cancer detection rates.

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.…”

“…However, the latter study was underpowered to demonstrate any significant increase in cancer detection rate. Rose et al 60 conducted an observational study to assess changes in screening performance measures after the introduction of DBT. Six radiologists interpreted 13,586 screening mammography studies without DBT and 9499 studies with the addition of DBT.…”