Brian Haas MD, Presenter: Nothing to Disclose

Vivek Bihari Kalra MD, Abstract Co-Author: Nothing to Disclose

Madhavi Raghu MD, Abstract Co-Author: Nothing to Disclose

Liane Elizabeth Philpotts MD, Abstract Co-Author: Nothing to Disclose

Tomosynthesis is an emerging technology in the field of breast imaging. Used as a screening modality, it has the potential to reduce patient recall rates and increase cancer detection rates. We sought to evaluate the performance of breast tomosynthesis during screening mammography compared to conventional digital imaging alone.

All patients presenting for screening mammograms from October 1, 2011 through March 1, 2012 at four clinical sites were identified for review. One of these sites has a digital tomosynthesis unit (Dimensions, Hologic, Bedford, MA), and patients at this site were offered screening with tomosynthesis, performed in conjunction with conventional digital mammography (3D+2D). Patients at the other sites underwent conventional (2D) digital mammography (Selenia, Hologic). Recall rates (BIRADS 0) were calculated for the two groups overall, and were stratified by breast density and age. Cancer detection rates were also calculated.

5780 patients presented for screening mammography, of which 1602 received tomosynthesis (3D+2D). The overall recall rate for patients in the tomosynthesis group was 7.0% compared to 10.9% for conventional imaging alone (p value < 0.01). Recall rates stratified by breast density and patient age (Figure 1) demonstrated reduced recall rates for all density and age groups, with significant differences found for heterogeneously dense breasts (7.7% vs. 14.8%, p < 0.01) and extremely dense breasts (2.2% vs 17.1%, p < 0.01), and for patients younger than 40 years (4.1% vs 20.5%, p = 0.01) and aged 40-49 years (7.0% vs 16.4%, p < 0.01)(3D+2D vs 2D, respectively). On follow-up there were 9 cancers found in patients receiving tomosynthesis, for an overall cancer detection rate of 5.6 per 1000; in patients receiving 2D imaging alone, there were 14 cancers, for a detection rate of 3.4 per 1000 (p = 0.24).

Patients undergoing tomosynthesis in addition to conventional digital mammography had significantly lower recall rates. In particular patients with dense breasts, and patients aged younger than 50 benefited the most. There was also a trend for a higher cancer detection rate for screening with tomosynthesis than with 2D imaging alone.

Screening breast tomosynthesis reduces recall rates with a trend for an improved cancer detection rate. Tomosynthesis promises to have a profound effect on the performance of screening mammography.

Haas, B, Kalra, V, Raghu, M, Philpotts, L, Performance of Digital Breast Tomosynthesis Compared to Conventional Digital Mammography for Breast Cancer Screening.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12023567.html