Digital breast tomosynthesis (DBT): a review of the evidence for use as a screening tool

Abstract

Breast screening with full-field digital mammography (FFDM) fails to detect 15-30% of cancers. This figure is higher for women with dense breasts. A new tomographic technique in mammography has been developed--digital breast tomosynthesis (DBT)--which allows images to be viewed in sections through the breast and has the potential to improve cancer detection rates. Results from retrospective reading studies comparing DBT with FFDM have been largely favourable with improvement in sensitivity and specificity. Increases in diagnostic accuracy have been reported as being independent of breast density; however there are mixed reports regarding the detection of microcalcification. Prospective screening studies using DBT with FFDM have demonstrated increased rates in cancer detection compared with FFDM alone. A reduction in false-positive recall rates has also been shown. Screening with the addition of DBT would approximately double radiation dose; however a simulated FFDM image can be generated from a DBT scan. The combination of simulated FFDM images and DBT is being evaluated within several studies and some positive results have been published. Interval cancer rates for the UK National Health Service Breast Screening Programme (NHSBSP) demonstrate the limited sensitivity of FFDM in cancer detection. DBT has the potential to increase sensitivity and decrease false-positive recall rates. It has approval for screening and diagnostics in several countries; however, there are issues with DBT as a screening tool including additional reading time, IT storage and connectivity, over-diagnosis, and cost effectiveness. Feasibility and cost-effectiveness trials are needed before the implementation of DBT in NHSBSP can be considered.

Characterization of Breast Masses in Digital Breast Tomosynthesis and Digital Mammograms

“…All these studies found significant improvement in cancer detection rate and a reduction in the overall recall rate or a reduction in the recall rate per cancer detected. Other investigators have conducted retrospective reader studies as reviewed in (11, 12); most of these studies also revealed the potential of the combo mode, yielding higher cancer detection rate and lower recall rate compared to DM alone.…”

Position paper on screening for breast cancer by the European Society of Breast Imaging (EUSOBI) and 30 national breast radiology bodies from Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Israel, Lithuania, Moldova, The Netherlands, Norway, Poland, Portugal, Romania, Serbia, Slovakia, Spain, Sweden, Switzerland and Turkey

“…First results on a reduction from 0.7 to 0.5 interval cancers per 100 screened women were very recently reported from a large study in the USA [31], but further evidence is needed. Moreover, the probable increase in reading time associated with the use of DBT in screening [32] and its effects on sustainability of screening programmes should be considered before routine implementation.…”

Improving image quality for digital breast tomosynthesis: an automated detection and diffusion-based method for metal artifact reduction

“…DBT can reduce tissue overlap and improve the visualization of normal tissue and suspicious masses. A number of studies showed that DBT as an adjunct to mammography increased the sensitivity for detecting breast cancer and reduced recall rate in comparison to mammography alone (Ciatto et al 2013, Rose et al 2013, Skaane et al 2013a, Skaane et al 2013b, Friedewald et al 2014, Durand et al 2015, Bernardi et al 2016, Conant et al 2016, Gilbert et al 2016, Sharpe et al 2016). …”