Digital Breast Tomosynthesis Changes Management in Patients Seen at a Tertiary Care Breast Center

Abstract

Objectives. To study factors that predict changes in management with digital breast tomosynthesis (DBT). Methods. The Institutional Review Board approved this HIPAA compliant study. 996 patients had DBT with full field digital mammography (FFDM). Univariate analysis evaluated predictors of management change and cancer detection. Results. DBT changed management in 109 of 996 (11%); 77 (71%) required less imaging. Recalled patients after abnormal FFDM screen were most likely to have management change—25% (24 of 97 patients) compared to 8% (13/163) of symptomatic patients and 10% (72/736) of screening patients (P < 0.001). Dense breasted patients had a higher likelihood of having DBT change management: 13% (68/526) compared to 9% (41/470) (P = 0.03). Of the 996 patients, 19 (2%) were diagnosed with breast cancer. 15 cancers (83%) were seen on FFDM and DBT; 3 (17%) were diagnosed after DBT (0.3%, 95%CI: 0.1–0.9%). One recurrence was in the skin and was not seen on DBT nor was it seen on FFDM. The increase in cancer detection rate was 17% for asymptomatic patients, 0% for symptomatic patients, and 100% for recalled patients. Conclusions. DBT increased cancer detection rate by 20% and decreased the recall rate in 8–25%. Advances in Knowledge. DBT led to a doubling of the cancer detection rate in recalled patients.

Strategies to Increase Cancer Detection: Review of True-Positive and False-Negative Results at Digital Breast Tomosynthesis Screening

“…These benefits have been shown to be achievable across all breast densities but appear to be especially large in women younger than 50 years (6,7). In addition, Margolies et al (8) found that DBT significantly changed management in women with dense breasts (13% of cases) compared with women with less dense breasts (9% of cases) (P = .03). More recently, McDonald et al (14) have shown that improvements in screening outcomes with DBT were sustainable over consecutive years of screening in an entire clinic population.…”

“…Digital breast tomosynthesis (DBT) is rapidly being implemented in breast clinics as the "better mammogram" because it addresses some of the limitations of conventional two-dimensional mammography by alleviating the effect of superimposed structures that lead to both false-positive and false-negative results at breast cancer screening (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13).…”

Advancements in Imaging Technology for Detection and Diagnosis of Palpable Breast Masses

“…6 DBT became available in 2011 with many studies demonstrating its ability to improve the sensitivity of screening mammography compared with FFDM, while decreasing recall rates. 7 In the setting of diagnostic mammography for palpable mass, DBT is superior to FFDM for the characterization of the margins of masses noted on mammography. This knowledge may aid in differentiating benign from malignant lesions, resulting in fewer biopsies of benign lesions.…”

Screening for Dense Breasts: Digital Breast Tomosynthesis

“…The ability to view the breast in slices can provide improved lesion visibility within the cross section of the breast tissue. Early in the clinical implementation of DBT, the results of studies promised that DBT would help to improve the accuracy of diagnostic and screening mammography, reduce recall rates, and provide accurate 3D lesion localization [12][13][14][15][16][17][18][19][20].…”

“…When using DBT with FFDM for imaging patients with dense breasts, a proportionally greater advantage was seen when comparing AUCs: 0.877 for DBT with FFDM, 0.786 for FFDM alone, and 0.832 for FFDM with craniocaudal DBT. Margolies and colleagues [19] evaluated a cohort of patients at increased risk of breast cancer and investigated the effect of adding DBT on patient management. They found that patients with BI-RADS category 3 or 4 breast density had a significantly higher likelihood of having DBT findings that changed management (13% of patients with heterogeneously dense or extremely dense tissue vs 9% of patients with fatty or scattered tissue; p = 0.03).…”