Published Online:https://doi.org/10.1148/radiol.13130307

Although all breast density and age subgroups benefitted from the addition of tomosynthesis to conventional digital mammography, the patients receiving the greatest benefit were women with dense breasts and those younger than 50 years.

Purpose

To compare screening recall rates and cancer detection rates of tomosynthesis plus conventional digital mammography to those of conventional digital mammography alone.

Materials and Methods

All patients presenting for screening mammography between October 1, 2011, and September 30, 2012, at four clinical sites were reviewed in this HIPAA-compliant retrospective study, for which the institutional review board granted approval and waived the requirement for informed consent. Patients at sites with digital tomosynthesis were offered screening with digital mammography plus tomosynthesis. Patients at sites without tomosynthesis underwent conventional digital mammography. Recall rates were calculated and stratified according to breast density and patient age. Cancer detection rates were calculated and stratified according to the presence of a risk factor for breast cancer. The Fisher exact test was used to compare the two groups. Multivariate logistic regression was used to assess the effect of screening method, breast density, patient age, and cancer risk on the odds of recall from screening.

Results

A total of 13 158 patients presented for screening mammography; 6100 received tomosynthesis. The overall recall rate was 8.4% for patients in the tomosynthesis group and 12.0% for those in the conventional mammography group (P < .01). The addition of tomosynthesis reduced recall rates for all breast density and patient age groups, with significant differences (P < .05) found for scattered fibroglandular, heterogeneously dense, and extremely dense breasts and for patients younger than 40 years, those aged 40–49 years, those aged 50–59 years, and those aged 60–69 years. These findings persisted when multivariate logistic regression was used to control for differences in age, breast density, and elevated risk of breast cancer. The cancer detection rate was 5.7 per 1000 in patients receiving tomosynthesis versus 5.2 per 1000 in patients receiving conventional mammography alone (P = .70).

Conclusion

Patients undergoing tomosynthesis plus digital mammography had significantly lower screening recall rates. The greatest reductions were for those younger than 50 years and those with dense breasts. A nonsignificant 9.5% increase in cancer detection was observed in the tomosynthesis group.

© RSNA, 2013

References

  • 1. Fletcher SW, Black W, Harris R, Rimer BK, Shapiro S. Report of the International Workshop on Screening for Breast Cancer. J Natl Cancer Inst 1993;85(20):1644–1656. Crossref, MedlineGoogle Scholar
  • 2. Lewin JM, Hendrick RE, D’Orsi CJ, et al. Comparison of full-field digital mammography with screen-film mammography for cancer detection: results of 4,945 paired examinations. Radiology 2001;218(3):873–880. LinkGoogle Scholar
  • 3. Pisano ED, Gatsonis C, Hendrick E, et al. Diagnostic performance of digital versus film mammography for breast-cancer screening. N Engl J Med 2005;353(17):1773–1783. [Published correction appears in N Engl J Med 2006;355(17):1840.] Crossref, MedlineGoogle Scholar
  • 4. Nelson HD, Tyne K, Naik A, et al. Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Ann Intern Med 2009;151(10):727–737, W237–W242. Crossref, MedlineGoogle Scholar
  • 5. Baker JA, Lo JY. Breast tomosynthesis: state-of-the-art and review of the literature. Acad Radiol 2011;18(10):1298–1310. Crossref, MedlineGoogle Scholar
  • 6. Park JM, Franken EA Jr, Garg M, Fajardo LL, Niklason LT. Breast tomosynthesis: present considerations and future applications. RadioGraphics 2007;27(Suppl 1):S231–S240. LinkGoogle Scholar
  • 7. Niklason LT, Christian BT, Niklason LE, et al. Digital tomosynthesis in breast imaging. Radiology 1997;205(2):399–406. LinkGoogle Scholar
  • 8. Poplack SP, Tosteson TD, Kogel CA, Nagy HM. Digital breast tomosynthesis: initial experience in 98 women with abnormal digital screening mammography. AJR Am J Roentgenol 2007;189(3):616–623. Crossref, MedlineGoogle Scholar
  • 9. Gur D, Abrams GS, Chough DM, et al. Digital breast tomosynthesis: observer performance study. AJR Am J Roentgenol 2009;193(2):586–591. Crossref, MedlineGoogle Scholar
  • 10. Rafferty EA, Park JM, Philpotts LE, et al. Assessing radiologist performance using combined digital mammography and breast tomosynthesis compared with digital mammography alone: results of a multicenter, multireader trial. Radiology 2013;266(1):104–113. LinkGoogle Scholar
  • 11. Skaane P, Bandos AI, Gullien R, et al. Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology 2013;267(1):47–56. LinkGoogle Scholar
  • 12. Defrank JT, Brewer N. A model of the influence of false-positive mammography screening results on subsequent screening. Health Psychol Rev 2010;4(2):112–127. Crossref, MedlineGoogle Scholar
  • 13. DeFrank JT, Rimer BK, Bowling JM, Earp JA, Breslau ES, Brewer NT. Influence of false-positive mammography results on subsequent screening: do physician recommendations buffer negative effects? J Med Screen 2012;19(1):35–41. Crossref, MedlineGoogle Scholar
  • 14. Brewer NT, Salz T, Lillie SE. Systematic review: the long-term effects of false-positive mammograms. Ann Intern Med 2007;146(7):502–510. Crossref, MedlineGoogle Scholar
  • 15. Noroozian M, Hadjiiski L, Rahnama-Moghadam S, et al. Digital breast tomosynthesis is comparable to mammographic spot views for mass characterization. Radiology 2012;262(1):61–68. LinkGoogle Scholar
  • 16. Hendrick RE. Radiation doses and cancer risks from breast imaging studies. Radiology 2010;257(1):246–253. LinkGoogle Scholar
  • 17. FDA panel gives nod to 2D synthetic mode for Hologic breast tomo. Aunt Minnie Web site. http://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&itemid=100985. Accessed April 15, 2013. Google Scholar
  • 18. Berg WA, Blume JD, Cormack JB, et al. Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA 2008;299(18):2151–2163. Crossref, MedlineGoogle Scholar

Article History

Received February 5, 2013; revision requested March 26; revision received June 12; accepted June 14; final version accepted June 19.
Published online: Dec 2013
Published in print: Dec 2013