<p>The role of digital breast tomosynthesis in breast cancer screening: a manufacturer- and metrics-specific analysis</p>

Abstract

Aim: Digital Breast Tomosynthesis (DBT), with or without Digital Mammography (DM) or Synthetic Mammography (SM), has been introduced or is under consideration for its introduction in breast cancer screening in several countries, as it has been shown that it has advantages over DM. Despite this there is no agreement on how to implement DBT in screening, and in many cases there is a lack of official guidance on the optimum usage of each commercially available system. The aim of this review is to carry out a manufacturerspecific summary of studies on the implementation of DBT in breast cancer screening. Methods: An exhaustive literature review was undertaken to identify clinical observer studies that evaluated at least one of five common metrics: sensitivity, specificity, area under the curve (AUC) of the receiver-operating characteristics (ROC) analysis, recall rate and cancer detection rate. Four common DBT implementation methods were discussed in this review: (1) DBT, (2) DM with DBT, (3) 1-view DBT with or without 1-view DM or 2-view DM and (4) DBT with SM. Results: A summary of 89 studies, selected from a database of 677 studies, on the assessment of the implementation of DBT in breast cancer screening is presented in tables and discussed in a manufacturer-and metric-specific approach. Much more studies were carried out using some DBT systems than others. For one implementation method of DBT by one manufacturer there is a shortage of studies, for another implementation there are conflicting results. In some cases, there is a strong agreement between studies, making the advantages and disadvantages of each system clear. Conclusion: The optimum implementation method of DBT in breast screening, in terms of diagnostic benefit and patient radiation dose, for one manufacturer does not necessarily apply to other manufacturers.

Design of an in silico imaging trial with growing breast cancer lesions: comparison between DM and DBT detectability

“…For smaller masses, DM may present an advantage as seen in the case of micro-calcification detection t asks. 9 This longitudinal trial is the first in silico longitudinal trial reported that evaluates the performance of imaging modalities such as DM and DBT throughout the early stages of mass lesions. In the future, we plan to include larger variability in the trial population, a more sophisticated tumor growth model as well as in silico replicas of other commercially available DM/DBT systems.…”

Comparison of two-view versus single-view digital breast tomosynthesis and 2D-mammography in breast cancer surveillance imaging

“…As more extensively presented in Hadjipanteli et al 2019 [ 31 ], the combination of 1vDBT or 2vDBT with 1vDM or 2vDM was investigated in several studies [ 1 , 2 , 4 , 43 – 46 ], with the difference that its implementation was in breast cancer screening and not surveillance imaging. Rafferty et al [ 4 ] showed that using Hologic 2vDM, 2vDM&1vDBT, and 2vDM&2vDBT the AUCs were 0.828, 0.864, and 0.895 respectively.…”

“…One solution to the increased patient dose, image interpretation time and storage capacity could potentially be the replacement of DM by SM [ 29 , 30 ] as it has been shown that SM is at least non inferior to DM. As more extensivity discussed in Hadjipanteli et al [ 31 ] several studies, carried out after Hologic SM was approved by FDA, support that the performance of SM is least equal in terms of sensitivity (43,44), specificity (44,45), AUC (97), cancer detection rate (97) and recall rate (100–103) However, work is still undertaken on the optimal utilization of SM [ 32 ] and there is therefore uncertainty on its use in screening. Furthermore, not all hospitals and breast imaging centres have the immediate financial capacity to get access to SM, as it requires at least a specialised image analysis software, which forms an additional separate cost to tomosynthesis and cannot always be easily justified.…”

Personalized breast cancer screening with selective addition of digital breast tomosynthesis through artificial intelligence

“…The longer reading time, together with the limited availability of equipment and higher total cost for DBT, are all barriers for a wider implementation 10 , 11 . Also, the organ dose is often higher with DBT, 12 though this may depend on equipment and way of implementation.…”