Digital Breast Tomosynthesis and Synthetic 2D Mammography versus Digital Mammography: Evaluation in a Population-based Screening Program

Abstract

Purpose To compare the performance of digital breast tomosynthesis (DBT) and two-dimensional synthetic mammography (SM) with that of digital mammography (DM) in a population-based mammographic screening program. Materials and Methods In this prospective cohort study, data from 37 185 women screened with DBT and SM and from 61 742 women screened with DM as part of a population-based screening program in 2014 and 2015 were included. Early performance measures, including recall rate due to abnormal mammographic findings, rate of screen-detected breast cancer, positive predictive value of recall, positive predictive value of needle biopsy, histopathologic type, tumor size, tumor grade, lymph node involvement, hormonal status, Ki-67 level, and human epidermal growth factor receptor 2 status were compared in women who underwent DBT and SM screening and in those who underwent DM screening by using χ tests, two-sample unpaired t tests, and tests of proportions. Results Recall rates were 3.4% for DBT and SM screening and 3.3% for DM screening (P = .563). DBT and SM screening showed a significantly higher rate of screen-detected cancer compared with DM screening (9.4 vs 6.1 cancers per 1000 patients screened, respectively; P < .001). The rate of detection of tumors 10 mm or smaller was 3.2 per 1000 patients screened with DBT and SM and 1.8 per 1000 patients screened with DM (P < .001), and the rate of grade 1 tumors was 3.3 per 1000 patients screened with DBT and SM versus 1.4 per 1000 patients screened with DM (P < .001). On the basis of immunohistochemical analyses, rates of lymph node involvement and tumor subtypes did not differ between women who underwent DBT and SM screening and those who underwent DM screening. Conclusion DBT and SM screening increased the detection rate of histologically favorable tumors compared with that attained with DM screening. RSNA, 2018 Online supplemental material is available for this article.

The threshold detectable mass diameter for 2D-mammography and digital breast tomosynthesis

“…A potential solution may lie in the use of synthetic imaging, which provides the generation of a synthesised 2D image from DBT data (and thus eliminating the use of 2Dmammography), and is available from some manufacturers. There are on-going studies on the use of synthetic imaging in screening [40][41][42][43] and the identification of its strengths and weaknesses [44].…”

Malignant Outcomes of Architectural Distortion on Tomosynthesis: A Systematic Review and Meta-Analysis

“…Digital breast tomosynthesis (DBT) is being increasingly used in clinical practice given that it increases cancer detection rate [1][2][3][4][5], reduces recall rate [2,3,6,7], and improves overall diagnostic accuracy [6,8]. DBT increases conspicuity of lesions and allows for identification of lesions that may be occult or observed only retrospectively on digital mammography (DM), such as architectural distortion.…”

Microcalcifications Detected at Screening Mammography: Synthetic Mammography and Digital Breast Tomosynthesis versus Digital Mammography

“…More recently, Aujero et al found no significant difference in DCIS detection rates in their community practice when switching from FFDM plus DBT to SM plus DBT (26). Population screening results comparing SM plus DBT to conventional digital mammography found an increase in DCIS detection with SM plus DBT versus conventional digital mammography (27). These more recent study results suggest that SM may be sufficient to detect clinically significant microcalcifications.…”