Prospective study of breast tomosynthesis as a triage to assessment in screening
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There is limited evidence on the role of 3D mammography with tomosynthesis in breast screening, although early studies suggest that it may improve specificity. We prospectively evaluated the effect of integrating 3D mammography as a triage to assessment in 158 consecutive recalls to assessment (recalled in standard 2D-mammographic screening) in asymptomatic subjects. Radiologists provided 3D mammography-based opinion as to whether recall/assessment was warranted or unnecessary, and all subjects proceeded to assessment. 3D triage was positive (confirmed the need for assessment) in all 21 subjects with breast cancer (there were no false negatives), and would have avoided recall in 102 of 137 (74.4%) subjects with a negative/benign final outcome in whom 3D triage did not recommend recall. Proportion of true negative 3D triage (as a proxy for potential reduction in recalls) was slightly higher in dense than non-dense breasts, did not differ across age-groups, but was significantly associated with the type of lesion seen on imaging (being highest for distortions, asymmetric densities, and lesions with ill-defined margins). While the simulation design may have over-estimated the potential for 3D mammography triage to reduce recalls, this study clearly demonstrates its capability to improve breast screening specificity and to reduce recall rates. Future studies of 3D mammography should further assess its role as a recall-reducing strategy in screening practice and should include formal cost-analysis.
KeywordsBreast carcinoma Diagnosis Screening Mammography Tomosynthesis Recall rate
Dr Houssami is supported by the National Health and Medical Research Council program grant 633003 to the Screening and Test Evaluation Program.
Conflict of interest
The authors declare that they have no conflict of interest.
The study design complies with the current Italian laws.
- 1.Glasziou P, Houssami N (2011) The evidence base for breast cancer screening. Prev Med [Epud ahead of print]. doi: 10.1016/j.ypmed.2011.05.011
- 4.Lehman CD, White E, Peacock S et al (1999) Effect of age and breast density on screening mammograms with false positive findings. Am J Roentgenol 173:1651–1655Google Scholar
- 7.The National centre for Screening Monitoring: Eighth Report. http://win.osservatorionazionalescreening.it/eng-publications.php. Accessed 10 Oct 2011
- 8.Australian Institute of Health and Welfare (2009) BreastScreen Australia monitoring report 2005–2006. Cancer series no. 48. Cat. no. CAN 44. Canberra: AIHW. http://www.aihw.gov.au. Accessed 10 Oct 2011
- 11.Niklason LT, Christian BT, Niklason LE et al (1997) Digital breast tomosynthesis in breast imaging. Radiology 205:25–31Google Scholar
- 12.Rafferty EA, Georgian-Smith D, Kopans DB et al (2002) Comparison of full-field digital tomosynthesis with two view conventional film screen mammography in the prediction of lesion malignancy. Radiology 225:268Google Scholar
- 20.Rafferty EA, Smith AP, Niklason, LT (2009) Assessing radiologist performance in dense versus fatty breasts using combined full-field digital mammography and breast tomosynthesis compared to full-field digital mammography alone. Radiologic Society of North America 95th Scientific Assembly and Annual Meeting; Chicago, ILGoogle Scholar
- 21.Moore RH, Boston MA, Kopans DB, et al (2007) Initial callback rates for conventional and digital breast tomosynthesis mammography comparison in the screening setting. Radiologic Society of North America 92nd Scientific Assembly and Annual Meeting; Chicago, ILGoogle Scholar