Increased Cancer Detection Rate and Variations in the Recall Rate Resulting from Implementation of 3D Digital Breast Tomosynthesis into a Population-based Screening Program

Abstract

Purpose:To compare the recall and cancer detection rates (CDRs) at screening with digital breast tomosynthesis (DBT) with those at screening with two-dimensional (2D) mammography and to evaluate variations in the recall rate (RR) according to patient age, risk factors, and breast density and among individual radiologists at a single U.S. academic medical center. Materials and Methods:This institutional review board-approved, HIPAA-compliant prospective study with a retrospective cohort included 85 852 asymptomatic women who presented for breast cancer screening over a 3-year period beginning in 2011. A DBT unit was introduced into the existing 2D mammography screening program, and patients were assigned to the first available machine. Ten breast-subspecialized radiologists interpreted approximately 90% of the examinations. RRs were calculated overall and according to patient age, breast density, and individual radiologist. CDRs were calculated. Single and multiple mixed-effect logistic regression analyses, x 2 tests, and Bonferroni correction were utilized, as appropriate. Results:The study included 5703 (6.6%) DBT examinations and 80 149 (93.4%) 2D mammography examinations. The DBT subgroup contained a higher proportion of patients with risk factors for breast cancer and baseline examinations. DBT was used to detect 54.3% more carcinomas (+1.9 per 1000, P , .0018) than 2D mammography. The RR was 7.51% for 2D mammography and 6.10% for DBT (absolute change, 1.41%; relative change, -18.8%; P , .0001).The DBT subgroup demonstrated a significantly lower RR for patients with extremely or heterogeneously dense breasts and for patients in their 5th and 7th decades. Conclusion:Implementing DBT into a U.S. breast cancer screening program significantly decreased the screening RR overall and for certain patient subgroups, while significantly increasing the CDR. These findings may encourage more widespread adoption and reimbursement of DBT and facilitate improved patient selection.q RSNA, 2015

Utility of Clinical Breast Examinations in Detecting Local–Regional Breast Events After Breast-Conservation in Women with a Personal History of High-Risk Breast Cancer

“…The advent of digital mammograms increased the sensitivity of screening mammograms in challenging breasts, 17-19 and even better sensitivity and specificity may be observed with digital breast tomosynthesis. 20-22 Finally, our findings may reflect the increased awareness of breast cancer survivors to changes in their breasts. Given the high level of anxiety in this patient population, 23 it is likely that these patients are quick to bring any changes in their self-breast exam to their providers' attention.…”

Digital breast tomosynthesis for breast cancer screening and diagnosis in women with dense breasts – a systematic review and meta-analysis

“…Three studies did not specify density classification [22, 26, 28]. Three of 16 studies were at high risk of bias in terms of index test due to unspecified outcome definition [ 26 , 28 , 29 ]. .…”

“…When analysing data for different thresholds, the result of recall rate in screening studies using two study groups remained significantly lower for DBT compared to DM but the heterogeneity decreased. Studies defining BI-RADS 0 as recall [ 22 , 27 , 29 ] showed a larger decrease in recall rate than studies using a different definition (BI-RADS 0,3,4,5 [ 20 ] or BI-RADS 0,4,5 [ 25 ] or where unspecified [ 26 , 28 ]). Among four diagnostic studies reporting sensitivity and specificity, one study from the UK [ 21 ] used a lower threshold (BI-RADS 3 instead of BI-RADS 4) and reported lower specificity than other diagnostic studies which may account for more false positives.…”

Improving image quality for digital breast tomosynthesis: an automated detection and diffusion-based method for metal artifact reduction

“…DBT can reduce tissue overlap and improve the visualization of normal tissue and suspicious masses. A number of studies showed that DBT as an adjunct to mammography increased the sensitivity for detecting breast cancer and reduced recall rate in comparison to mammography alone (Ciatto et al 2013, Rose et al 2013, Skaane et al 2013a, Skaane et al 2013b, Friedewald et al 2014, Durand et al 2015, Bernardi et al 2016, Conant et al 2016, Gilbert et al 2016, Sharpe et al 2016). …”