Five Consecutive Years of Screening with Digital Breast Tomosynthesis: Outcomes by Screening Year and Round
Abstract
The sensitivity of digital breast tomosynthesis (DBT) was higher than that of digital mammography (DM) in each of the first 5 years after implementation of DBT. DBT also helped detect a higher proportion of poor-prognosis cancers than DM did.
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 (± standard deviation) was 56 years ±11 for the entire cohort, 55 years ±11 for the DBT group, and 57 years ±11 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.
© RSNA, 2020
Online supplemental material is available for this article.
See also the editorial by Moy and Heller in this issue.
References
- 1. . Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology 2013;267(1):47–56.
- 2. . Integration of 3D digital mammography with tomosynthesis for population breast cancer screening (STORM): A prospective comparison study. Lancet Oncol 2013;14(7):583–589.
- 3. . Performance of one-view breast tomosynthesis as a stand-alone breast cancer screening modality: Results from the Malmö Breast Tomosynthesis Screening Trial, a population-based study. Eur Radiol 2016;26(1):184–190.
- 4. . Digital Breast Tomosynthesis with Synthesized Two-Dimensional Images versus Full-Field Digital Mammography for Population Screening: Outcomes from the Verona Screening Program. Radiology 2018;287(1):37–46.
- 5. . Digital Breast Tomosynthesis and Synthetic 2D Mammography versus Digital Mammography: Evaluation in a Population-based Screening Program. Radiology 2018;287(3):787–794.
- 6. . Comparison of tomosynthesis plus digital mammography and digital mammography alone for breast cancer screening. Radiology 2013;269(3):694–700.
- 7. . Implementation of breast tomosynthesis in a routine screening practice: An observational study. AJR Am J Roentgenol 2013;200(6):1401–1408.
- 8. . Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA 2014;311(24):2499–2507.
- 9. . Screening outcomes following implementation of digital breast tomosynthesis in a general-population screening program. J Natl Cancer Inst 2014;106(11):dju316.
- 10. . Early clinical experience with digital breast tomosynthesis for screening mammography. Radiology 2015;274(1):85–92.
- 11. . Breast cancer screening using tomosynthesis in combination with digital mammography compared to digital mammography alone: A cohort study within the PROSPR consortium. Breast Cancer Res Treat 2016;156(1):109–116.
- 12. . Breast Cancer Screening Using Tomosynthesis or Mammography: A Meta-analysis of Cancer Detection and Recall. J Natl Cancer Inst 2018;110(9):942–949.
- 13. . Clinical implementation of digital breast tomosynthesis. Radiol Clin North Am 2014;52(3):499–518.
- 14. . Strategies to Increase Cancer Detection: Review of True-Positive and False-Negative Results at Digital Breast Tomosynthesis Screening. RadioGraphics 2016;36(7):1954–1965.
- 15. . Breast Cancer Conspicuity on Simultaneously Acquired Digital Mammographic Images versus Digital Breast Tomosynthesis Images. Radiology 2019;292(1):69–76.
- 16. . Update of the Swedish two-county program of mammographic screening for breast cancer. Radiol Clin North Am 1992;30(1):187–210.
- 17. . Effectiveness of Digital Breast Tomosynthesis Compared with Digital Mammography: Outcomes Analysis From 3 Years of Breast Cancer Screening. JAMA Oncol 2016;2(6):737–743.
- 18. . Association of Digital Breast Tomosynthesis versus Digital Mammography with Cancer Detection and Recall Rates by Age and Breast Density. JAMA Oncol 2019;5(5):635–642.
- 19. . Screening outcome for consecutive examinations with digital breast tomosynthesis versus standard digital mammography in a population-based screening program. Eur Radiol 2019;29(12):6991–6999.
- 20. . Interval breast cancers in the ‘screening with tomosynthesis or standard mammography’ (STORM) population-based trial. Breast 2018;38:150–153.
- 21. . Association of Screening and Treatment with Breast Cancer Mortality by Molecular Subtype in US Women, 2000-2012. JAMA 2018;319(2):154–164 [Published correction appears in JAMA 2018;319(7):724.].
- 22. . ECOG-ACRIN Cancer Research Group. http://ecog-acrin.org/tmist. Accessed July 7, 2019.
- 23. . Is Tomosynthesis the Future of Breast Cancer Screening? Radiology 2018;287(1):47–48.
- 24. . Implementation of Synthesized Two-dimensional Mammography in a Population-based Digital Breast Tomosynthesis Screening Program. Radiology 2016;281(3):730–736.
- 25. . Baseline Screening Mammography: Performance of Full-Field Digital Mammography Versus Digital Breast Tomosynthesis. AJR Am J Roentgenol 2015;205(5):1143–1148.
- 26. . BI-RADS category 3 comparison: Probably benign category after recall from screening before and after implementation of digital breast tomosynthesis. Radiology 2017;285(3):778–787.
- 27. . BI-RADS: Mammography. In: D’Orsi CJ, Mendelson EB, Ikeda DM, . Breast Imaging Reporting and Data System: ACR BI-RADS – Breast Imaging Atlas. 4th ed. Reston, Va: American College of Radiology, 2003.
- 28. . ACR BI-RADS Mammography. In: D’Orsi CJ, Sickles EA, Mendelson EB, . ACR BI-RADS Atlas, Breast Imaging Reporting and Data Systems. 5th ed. Reston, Va: American College of Radiology, 2013.
- 29. . Standardization and control for confounding in observational studies: A historical perspective. Stat Sci 2014;29(4):529–558.
- 30. . One-view breast tomosynthesis versus two-view mammography in the Malmö Breast Tomosynthesis Screening Trial (MBTST): A prospective, population-based, diagnostic accuracy study. Lancet Oncol 2018;19(11):1493–1503.
- 31. . Biologic Profiles of Invasive Breast Cancers Detected Only with Digital Breast Tomosynthesis. AJR Am J Roentgenol 2017;209(6):1411–1418.
- 32. . Breast cancers found with digital breast tomosynthesis: A comparison of pathology and histologic grade. Breast J 2016;22(6):651–656.
- 33. . Performance of breast cancer screening using digital breast tomosynthesis: Results from the prospective population-based Oslo Tomosynthesis Screening Trial. Breast Cancer Res Treat 2018;169(3):489–496.
- 34. . Breast cancer characteristics associated with 2D digital mammography versus digital breast tomosynthesis for screening-detected and interval cancers. Radiology 2018;287(1):49–57.
- 35. . Comparison of breast cancers detected in the Verona screening program following transition to digital breast tomosynthesis screening with cancers detected at digital mammography screening. Breast Cancer Res Treat 2018;170(2):391–397.
- 36. . The Coming of Age of Breast Tomosynthesis in Screening. Radiology 2019;291(1):31–33.
- 37. . Overdiagnosis in mammography screening: A 45-year journey from shadowy idea to acknowledged reality. BMJ 2015;350:h867.
Article History
Received: Aug 9 2019Revision requested: Sept 24 2019
Revision received: Nov 27 2019
Accepted: Dec 12 2019
Published online: Mar 10 2020
Published in print: May 2020