Breast Tomosynthesis Technique May Help Reduce Breast Cancer Screening Recall Rate

A new digital breast tomosynthesis technique has the potential to reduce the rate at which women are called back for additional examinations without sacrificing cancer detection, according to a study published in Radiology.

Digital breast tomosynthesis (DBT) in conjunction with full-field digital mammography (FFDM) has been shown to improve cancer detection and reduce callbacks for additional examinations. However, the combination of the two methods requires a second radiation exposure to the breast and also slightly more time for women in breast compression. Researchers at Christiana Care Health System developed a DBT technique that may eliminate the need for FFDM.

Researchers have been exploring a relatively new approach in which the DBT images are used to create a synthesized 2-D (s2D) compilation image. The method has the potential to render FFDM unnecessary. Investigators compared the clinical performance of DBT-s2D with that of DBT-FFDM and FFDM alone. They studied 78,810 screening mammograms performed from 2011 to 2016. In the study group, 32,076 women were screened with FFDM, 30,561 women were screened using DBT-FFDM, and 16,173 women were screened using DBT-s2D.

The study demonstrated that DBT-s2D’s recall rate was only 4.3% compared with 5.8% for DBT-FFDM. Overall cancer detection rates were similar. However, DBT-s2D detected 76.5% of invasive cancers compared with 61.3% for DBT-FFDM. At 3.6%, the false ̶positive rate for DBT-s2D was significantly lower than the 5.2% rate for DBT-FFDM. The positive predictive value of biopsy for DBT-s2D was 40.8% compared to 28.5% for DBT-FFDM.

Dr Jacqueline Holt, director of Breast Imaging at Christiana Care Health System said: “The adoption of s2D mammography combined with DBT into screening programs would limit radiation exposure to the patient, and, on the basis of our results, may improve clinical performance.”

Bottom line: Advanced imaging techniques such as 3D tomosynthesis with synthesized 2D images have the potential to reduce radiation exposure and improve breast cancer detection when compared to stand-alone 2D full field digital mammography or the combination of 2D full field digital mammography with 3D tomosnthesis mammography.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Women’s Imaging Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area.