Changes in Recall Type and Patient Treatment Following Implementation of Screening Digital Breast Tomosynthesis
Abstract
Our study showed a decreased recall rate without a change in the positive predictive value for biopsy or cancer detection rate with digital breast tomosynthesis along with fewer recalls for asymmetries and more recalls for masses, calcifications, and areas of architectural distortion.
Purpose
To compare recall rate, types of abnormalities recalled, additional imaging required, biopsy positive predictive value (PPV), and cancer detection rate before and after implementation of screening digital breast tomosynthesis (DBT).
Materials and Methods
This retrospective analysis was approved by the institutional review board and complied with HIPAA. The requirement to obtain informed consent was waived. Results from all screening digital mammography (DM) examinations performed without tomosynthesis from March 1, 2011, through February 29, 2012, and DBT examinations performed from March 1, 2012, through February 28, 2013, were reviewed to identify all Breast Imaging Reporting and Data System (BI-RADS) category 0 examinations (needs additional imaging). Radiology and pathology reports were reviewed. The recall rate, biopsy PPV, and cancer detection rate were calculated. Statistical analysis was performed by using a two-proportions z test.
Results
The recall rate was 9.3% (1175 of 12 577 examinations; 95% confidence interval [CI]: 8.8%, 9.9%) for DM and 6.4% (827 of 12 921 examinations; 95% CI: 6.0%, 6.8%) for DBT, an overall reduction of 31% (P < .00001). The recall rate was lower with DM than with DBT for masses (8.9% vs 26.8%, respectively), distortions (0.6% vs 5.3%), and calcifications (13.4% vs 20.3%) (P < .0001 for all). The recall rate was lower with DBT than with DM for asymmetries (13.3% vs 32.2%, respectively) and focal asymmetries (18.2% vs 32.2%) (P < .0001 for both). Diagnostic evaluation with ultrasonography (US) increased with DBT at the time of additional imaging (2.6% for DM vs 28.3% for DBT, P < .0001). There was no significant difference between DM and DBT with regard to biopsy PPV (30.2% vs 23.8%, P = .21) or cancer detection rate per 1000 patients (5.4 vs 4.6, P = .44).
Conclusion
With DBT, the recall rate decreased and the biopsy PPV and cancer detection rate did not decrease. The distribution of recalled abnormalities changed, and more patients were evaluated with US only.
© RSNA, 2014
References
- 1. . Implementation of breast tomosynthesis in a routine screening practice: an observational study. AJR Am J Roentgenol 2013;200(6):1401–1408. Crossref, Medline, Google Scholar
- 2. . Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology 2013;267(1):47–56. Link, Google Scholar
- 3. . Digital breast tomosynthesis: initial experience in 98 women with abnormal digital screening mammography. AJR Am J Roentgenol 2007;189(3):616–623. Crossref, Medline, Google Scholar
- 4. . Digital breast tomosynthesis: observer performance study. AJR Am J Roentgenol 2009;193(2):586–591. Crossref, Medline, Google Scholar
- 5. . Comparison of tomosynthesis plus digital mammography and digital mammography alone for breast cancer screening. Radiology 2013;269(3):694–700. Link, Google Scholar
- 6. . A model of the influence of false-positive mammography screening results on subsequent screening. Health Psychol Rev 2010;4(2):112–127. Crossref, Medline, Google Scholar
- 7. . Influence of false-positive mammography results on subsequent screening: do physician recommendations buffer negative effects? J Med Screen 2012;19(1):35–41. Crossref, Medline, Google Scholar
- 8. . Systematic review: the long-term effects of false-positive mammograms. Ann Intern Med 2007;146(7):502–510. Crossref, Medline, Google Scholar
- 9. . Cumulative probability of false-positive recall or biopsy recommendation after 10 years of screening mammography: a cohort study. Ann Intern Med 2011;155(8):481–492. Crossref, Medline, Google Scholar
- 10. . Breast tomosynthesis: state-of-the-art and review of the literature. Acad Radiol 2011;18(10):1298–1310. Crossref, Medline, Google Scholar
- 11. . Application of breast tomosynthesis in screening: incremental effect on mammography acquisition and reading time. Br J Radiol 2012;85(1020):e1174–e1178. Crossref, Medline, Google Scholar
- 12. . Breast imaging reporting and data system. 4th ed. Reston, Va: American College of Radiology, 2003. Google Scholar
- 13. . Auditing and benchmarks in screening and diagnostic mammography. Radiol Clin North Am 2007;45(5):791–800, vi. Crossref, Medline, Google Scholar
- 14. . Digital tomosynthesis in breast imaging. Radiology 1997;205(2):399–406. Link, Google Scholar
- 15. . Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study. Lancet Oncol 2013;14(7):583–589. Crossref, Medline, Google Scholar
- 16. . Digital breast tomosynthesis is comparable to mammographic spot views for mass characterization. Radiology 2012;262(1):61–68. Link, Google Scholar
- 17. . Can digital breast tomosynthesis replace conventional diagnostic mammography views for screening recalls without calcifications? A comparison study in a simulated clinical setting. AJR Am J Roentgenol 2013;200(2):291–298. Crossref, Medline, Google Scholar
- 18. . Digital breast tomosynthesis in the diagnostic environment: a subjective side-by-side review. AJR Am J Roentgenol 2010;195(2):W172–W176. Crossref, Medline, Google Scholar
- 19. . Digital breast tomosynthesis versus supplemental diagnostic mammographic views for evaluation of noncalcified breast lesions. Radiology 2013;266(1):89–95. Link, Google Scholar
- 20. . Likelihood of malignant disease for various categories of mammographically detected, nonpalpable breast lesions. Mayo Clin Proc 1993;68(5):454–460. Crossref, Medline, Google Scholar
- 21. . The adjunctive digital breast tomosynthesis in diagnosis of breast cancer. Biomed Res Int 2013;2013:597253. Crossref, Medline, Google Scholar
- 22. . Digital breast tomosynthesis (DBT): initial experience in a clinical setting. Acta Radiol 2012;53(5):524–529. Crossref, Medline, Google Scholar
- 23. . Calcifications in the breast and digital breast tomosynthesis. Breast J 2011;17(6):638–644. Crossref, Medline, Google Scholar
- 24. . Detection and classification of calcifications on digital breast tomosynthesis and 2D digital mammography: a comparison. AJR Am J Roentgenol 2011;196(2):320–324. Crossref, Medline, Google Scholar
- 25. . 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. Link, Google Scholar
- 26. . Prospective trial comparing full-field digital mammography (FFDM) versus combined FFDM and tomosynthesis in a population-based screening programme using independent double reading with arbitration. Eur Radiol 2013;23(8):2061–2071. Crossref, Medline, Google Scholar
Article History
Received February 6, 2014; revision requested March 18; revision received July 1; accepted July 15; final version accepted July 29.Published online: Sept 22 2014
Published in print: Feb 2015







