1. Combined tomosynthesis and digital mammography results in a lower recall rate and higher cancer detection rate.
2. Digital mammography alone resulted in a lower positive predictive value than when combined with tomosynthesis.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Digital tomosynthesis is a relatively new breast cancer screening tool, having just been approved by the United States Food and Drug Administration in 2011. The approval is dependent on digital tomosynthesis being used in conjunction with standard digital mammography. Digital tomosynthesis holds a promising position in the future of breast cancer screening due to its ability to acquire a three dimensional image of the breast while reducing false positive results and over diagnosis. This is in contrast to the two dimensional, and many times unclear, image provided by standard mammography. For these reasons, the authors of this study set out to determine whether digital mammography alone or digital mammography + digital tomosynthesis would provided better diagnostic outcomes.
The study concluded that the implementation of tomosynthesis plus digital mammography led to an increase in the cancer detection rate and a simultaneous decrease in recall rate (proportion of women needing addition imaging after initial screening). The use of digital mammography and tomosynthesis further resulted in an increase in positive predictive value and ability to detect invasive or ductal carcinoma in situ (DCIS) cancers. This study provides an excellent argument for the concurrent use of digital mammography with tomosynthesis in the clincal setting. However, more research will be needed, as well as training by radiologists, due to tomosynthesis being such a novel diagnostic tool.
In-Depth [cross-sectional, multicenter study]: This study included total of 454,850 screening mammograms interpreted at 13 sites. Of these, 281,187 (61.8%) were performed using digital mammography alone and 173,663 (38.2%) used digital mammograhy + tomosynthesis. A decrease in recall rate was of -16 (95%CI, -18 to -14; P< .001) per 1000 screens was observed for the later group. The percentage of biopsies were also an increased in the digital mammography plus tomosynthesis group (3285 (19.3%) vs. 5056 (18.1%)). This represents an increased rate of 1.3 biopsies per 1000 screens. An increase in cancer detection rate of 1.2 (95% CI, 0.8-1.6; P< .001) per 1000 was also observed for the digital mammography plus tomosynthesis group. Further, a 2.1% increase (95% CI, 1.7%-2.5%; P< .001) in positive predictive value was observed in the mammography plus tomosynthesis group.
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