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

Korhonen, Katrina; Weinstein, Susan P.; McDonald, Elizabeth S.; Conant, Emily F.

doi:10.1148/rg.2016160049

Cited by 34 publications

(13 citation statements)

References 35 publications

(44 reference statements)

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“…Despite these limitations, our study demonstrates that tomosynthesis can reduce the ambiguity of the final diagnosis and possibly increase the rate of both true-negative and true-positive cases, confirming the results of previous studies [24,36,37]. This leads to lower work-up rates and fewer supplementary breast ultrasounds and unnecessary biopsies, reducing the relative emotional, financial, and clinical costs [38,39].…”

Section: Discussionsupporting

confidence: 86%

Added Value of Digital Breast Tomosynthesis Combined with Digital Mammography According to Reader Agreement: Changes in BI-RADS Rate and Follow-Up Management

et al. 2017

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Background: The aim of this study was to evaluate the added value of digital breast tomosynthesis (DBT) when combined with digital mammography (DM) in BI-RADS assessment and follow-up management. Methods: From February 2014 to January 2015, 214 patients underwent DM and DBT, acquired with a Siemens Mammomat Inspiration unit. 2 expert readers independently reviewed the studies in 2 steps: DM and DM+DBT, according to BI-RADS rate. Patients with BI-RADS 0, 3, 4, and 5 were recalled for work-up. Inter-reader agreement for BI-RADS rate and work-up rate were evaluated using Cohen's kappa. Results: Inter-reader agreement (κ value) for BI-RADS classification was 0.58 for DM and 0.8 for DM+DBT. DM+DBT increased the number of BI-RADS 1, 2, 4, 5 and reduced the number of BI-RADS 0 and 3 for both readers compared to DM alone. Regarding work-up rate agreement, κ was poor for DM and substantial (0.7) for DM+DBT. DM+DBT also reduced the work-up rate for both Reader 1 and Reader 2. Conclusion: DM+DBT increased the number of negative and benign cases (BI-RADS 1 and 2) and suspicious and malignant cases (BI-RADS 4 and 5), while it reduced the number of BI-RADS 0 and 3. DM+DBT also improved inter-reader agreement and reduced the overall recall for additional imaging or short-interval follow-up.

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Section: Discussionsupporting

confidence: 86%

Added Value of Digital Breast Tomosynthesis Combined with Digital Mammography According to Reader Agreement: Changes in BI-RADS Rate and Follow-Up Management

et al. 2017

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“…Although DBT screening has been shown to help detect more cancers thus far, the additional cancers have been mostly luminal A subtypes, which are associated with better prognoses. Such lower-grade cancers most often manifest at mammographic screening as areas of architectural distortion that, even when subtle, are more conspicuous at DBT compared with imaging with digital mammography (DM) alone (14,15). However, studies evaluating subtypes of cancers detected at DBT versus DM screening 92.07%, 83.14%, 89.29%, 80.42%; DM = 84.82%; P = .10) at each DBT round were not different for DBT compared with DM.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent meta-analysis of pooled data from prospective European trials and observational U.S. studies, DBT screening was associated with higher increases in cancer detection rates (CDRs) in Europe than in the United States, and greater reductions in recall in the United States than in Europe, where recall rates (RRs) are generally much lower (12). In all settings, the improved outcomes achieved with tomosynthesis are attributed to the increased conspicuity of both benign and malignant lesions and the decrease in tissue superimposition obtained with the quasi-threedimensional format of DBT imaging (13)(14)(15).…”

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confidence: 99%

Five Consecutive Years of Screening with Digital Breast Tomosynthesis: Outcomes by Screening Year and Round

Conant

McDonald

et al. 2020

Radiology

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Background: Limited data exist beyond prevalence rounds of digital breast tomosynthesis (DBT) screening.Purpose: To compare DBT outcomes over multiple years and rounds to outcomes of digital mammography (DM) screening. Materials and Methods:Retrospective analysis included 1 year of DM and 5 years of DBT screening (September 2011 to September 2016); 67 350 examinations were performed in 29 310 women. Recall rate (RR) percentage, cancer detection rate (CDR) per 1000 women screened, false-negative rate per 1000 women screened, positive predictive value of recall (PPV1) percentage, positive predictive value of biopsies performed percentage, sensitivity, and specificity were calculated. Cancers diagnosed within 1 year of screening were captured by means of linkage to state cancer registry, and biologic characteristics were grouped by prognostic factors. Performance trends across DBT rounds were compared with those from DM rounds by using logistic regression to account for examinations in the same woman. Analyses were adjusted for age, race, breast density, baseline examination, and reader.Results: There were 56 839 DBT and 10 511 DM examinations. The mean patient age (6 standard deviation) was 56 years 611 for the entire cohort, 55 years 611 for the DBT group, and 57 years 611 for the DM group. RRs were significantly lower for the DBT group (8.0%, 4522 of 56 839; 95% confidence interval [CI]: 7.7, 8.2) than for the DM group (10.4%, 1094 of 10 511; 95% CI: 9.8, 11.0) (P , .001). CDRs were higher with DBT (6.0 per 1000 women screened; 95% CI: 5.4, 6.7 per 1000 women screened; 340 of 56 839) than with DM (5.1 per 1000 women screened; 95% CI: 3.9, 6.6 per 1000 women screened; 54 of 10 511) (P = .25), but this difference was not statistically significant. Both RR and CDR remained improved compared with DM for 5 years of DBT at the population level. False-negative rates were slightly lower for DBT (0.6 per 1000 women screened; 95% CI: 0.4, 0.8 per 1000 women screened; 33 of 56 839) than DM (0.9 per 1000 women screened; 0.4, 1.6 per 1000 women screened; nine of 10 511) overall (P = .30), but the difference was not statistically significant. In adjusted analyses, RR, biopsy recommendation rates, and PPV1 were improved for DBT versus DM (P  .001). Compared with DM, a higher proportion of DBT-detected cancers were invasive (70% [238 of 340] vs 68.5% [37 of 54]) and had poor prognoses characteristics (32.6% [76 of 233] vs 25.0% [nine of 36]). Conclusion:Favorable outcomes with digital breast tomosynthesis screening were sustained over multiple years and rounds. Digital breast tomosynthesis screening was associated with detection of a higher proportion of poor-prognosis cancers than was digital mammography.

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“…Many countries offer breast cancer screening programs, and these programs have been shown to decrease breast cancer mortality by 15%–30% 5. On the other hand, screening is associated with risks of false-positive, false-negative, and over-diagnosis 6,7. Ultrasound is often used as an adjunct to mammography for screening to enable early diagnosis of breast cancer worldwide.…”

Section: Introductionmentioning

confidence: 99%

“… 5 On the other hand, screening is associated with risks of false-positive, false-negative, and over-diagnosis. 6 , 7 Ultrasound is often used as an adjunct to mammography for screening to enable early diagnosis of breast cancer worldwide. An optimal screening tool should have both high sensitivity and specificity, but both mammography and B-mode ultrasound have sensitivity <75%.…”

Section: Introductionmentioning

confidence: 99%

<p>A multicenter study of a contrast-enhanced ultrasound diagnostic classification of breast lesions</p>

Tang

Chen

et al. 2019

CMAR

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PurposeTo evaluate a classification model of contrast-enhanced ultrasound (CEUS) and examine the characteristics of patients with false-negative diagnosis.Patients and methodsA retrospective secondary analysis of a multicenter trial of CEUS for breast cancer diagnosis (from August 2015 to April 2017) was undertaken. Patients (n=1,023) with Breast Imaging Reporting and Data System 4–5 lesions on B-mode ultrasound underwent CEUS. Pathological diagnoses were available from surgical or biopsy specimens for correlation. Lesion maximum diameter (LMD), distance to the papilla (DtP), distance from the superficial edge of the lesion to the skin (DtS), distance from the deep edge of the lesion to the pectoralis muscle (DtPM), and body mass index (BMI) were evaluated.ResultsMedian age and BMI were 48.0 and 41.2 years and 23.2 and 22.4 kg/m2 for patients with malignant and benign lesions, respectively. Overall sensitivity, specificity, and accuracy of CEUS for malignancy were 89.4%, 65.3%, and 75.8%, respectively. The patients with true-positive and false-negative diagnosis (ie, with malignant lesion) were older than those with false-positive and true-negative diagnosis (ie, with benign lesion). Patients with true-positive and false-positive diagnoses had higher BMI than patients with true-negative and false-negative diagnoses (P=0.004). Patients with true-positive and false-negative diagnoses had larger LMD and DtP, as well as smaller DtS and DtPM.ConclusionOlder age, higher BMI, larger LMD and DtP, and smaller DtS and DtPM were associated with malignant lesions on CEUS. Patients with these characteristics should undergo further imaging.

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

Abstract: Abbreviations: BI-RADS = Breast ImagingReporting and Data System, CC = craniocaudal, DBT = digital breast tomosynthesis, DM = digital mammography, MIP = maximum intensity projection, MLO = mediolateral oblique

Cited by 34 publications

References 35 publications

Added Value of Digital Breast Tomosynthesis Combined with Digital Mammography According to Reader Agreement: Changes in BI-RADS Rate and Follow-Up Management

Added Value of Digital Breast Tomosynthesis Combined with Digital Mammography According to Reader Agreement: Changes in BI-RADS Rate and Follow-Up Management

Five Consecutive Years of Screening with Digital Breast Tomosynthesis: Outcomes by Screening Year and Round

<p>A multicenter study of a contrast-enhanced ultrasound diagnostic classification of breast lesions</p>

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