Impact on the recall rate of digital breast tomosynthesis as an adjunct to digital mammography in the screening setting. A double reading experience and review of the literature

Abstract Objective To assess prospectively the interpretative performance of automated breast ultrasound (ABUS) as a supplemental screening after digital breast tomosynthesis (DBT) or as a standalone screening of women with dense breast tissue. Methods Under an IRB-approved protocol (written consent required), women with dense breasts prospectively underwent concurrent baseline DBT and ABUS screening. Examinations were independently evaluated, in opposite order, by two of seven Mammography Quality Standards Act–qualified radiologists, with the primary radiologist arbitrating disagreements and making clinical management recommendations. We report results for 1111 screening examinations (598 first year and 513 second year) for which all diagnostic workups are complete. Imaging was also retrospectively reviewed for all cancers. Statistical assessments used a 0.05 significance level and accounted for correlation between participants’ examinations. Results Of 1111 women screened, primary radiologists initially “recalled” based on DBT alone (6.6%, 73/1111, CI: 5.2%–8.2%), of which 20 were biopsied, yielding 6/8 total cancers. Automated breast ultrasound increased recalls overall to 14.4% (160/1111, CI: 12.4%–16.6%), with 27 total biopsies, yielding 1 additional cancer. Double reading of DBT alone increased the recall rate to 10.7% (119/1111), with 21 biopsies, with no improvement in cancer detection. Double reading ABUS increased the recall rate to 15.2% (169/1111, CI: 13.2%–17.5%) of women, of whom 22 were biopsied, yielding the detection of 7 cancers, including one seen only on double reading ABUS. Inter-radiologist agreement was similar for recall recommendations from DBT (κ = 0.24, CI: 0.14–0.34) and ABUS (κ = 0.23, CI: 0.15–0.32). Integrated assessments from both readers resulted in a recall rate of 15.1% (168/1111, CI: 13.1%–17.4%). Conclusion Supplemental or standalone ABUS screening detected cancers not seen on DBT, but substantially increased noncancer recall rates.

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Double reading of automated breast ultrasound with digital mammography or digital breast tomosynthesis for breast cancer screening

Clinical Imaging ◽

10.1016/j.clinimag.2019.01.019 ◽

2019 ◽

Vol 55 ◽

pp. 119-125 ◽

Cited By ~ 6

Author(s):

Janie M. Lee ◽

Savannah C. Partridge ◽

Geraldine J. Liao ◽

Daniel S. Hippe ◽

Adrienne E. Kim ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Digital Mammography ◽

Digital Breast Tomosynthesis ◽

Breast Ultrasound ◽

Breast Tomosynthesis ◽

Double Reading ◽

Automated Breast Ultrasound

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Screening Digital Mammography Recall Rate: Does It Change with Digital Breast Tomosynthesis Experience?

Radiology ◽

10.1148/radiol.2017170517 ◽

2018 ◽

Vol 286 (3) ◽

pp. 838-844 ◽

Cited By ~ 2

Author(s):

Olivia DiPrete ◽

Ana P. Lourenco ◽

Grayson L. Baird ◽

Martha B. Mainiero

Keyword(s):

Digital Mammography ◽

Digital Breast Tomosynthesis ◽

Recall Rate ◽

Breast Tomosynthesis

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Initial Experience with Combination Digital Breast Tomosynthesis Plus Full Field Digital Mammography or Full Field Digital Mammography Alone in the Screening Environment

Journal of Clinical Imaging Science ◽

10.4103/2156-7514.127838 ◽

2014 ◽

Vol 4 ◽

pp. 9 ◽

Cited By ~ 29

Author(s):

Stamatia Destounis ◽

Andrea Arieno ◽

Renee Morgan

Keyword(s):

Breast Cancer ◽

Digital Mammography ◽

Digital Breast Tomosynthesis ◽

Recall Rate ◽

Screening Mammography ◽

Breast Tomosynthesis ◽

Full Field ◽

Full Field Digital Mammography ◽

Significant Difference ◽

History Of

Objectives: Initial review of patients undergoing screening mammography imaged with a combination of digital breast tomosynthesis (DBT) plus full field digital mammography (FFDM) compared with FFDM alone. Materials and Methods: From June 2011 to December 2011, all patients presenting for routine screening mammography were offered a combination DBT plus FFDM exam. Under institutional review board approval, we reviewed 524 patients who opted for combination DBT plus FFDM and selected a sample group of 524 FFDM screening exams from the same time period for a comparative analysis. The χ2 (Chi-square) test was used to compare recall rates, breast density, personal history of breast cancer, and family history of breast cancer between the two groups. Results: Recall rate for FFDM, 11.45%, was significantly higher (P < 0001) than in the combination DBT plus FFDM group (4.20%). The biopsy rate in the FFDM group was 2.29% (12/524), with a cancer detection rate of 0.38% (2/524, or 3.8 per 1000) and positive predictive value (PPV) of 16.7% (2/12). The biopsy rate for the DBT plus FFDM group was 1.14% (n = 6/524), with a cancer detection rate 0.57% (n = 3/524, or 5.7 per 1000) and PPV of 50.0% (n = 3/6). Personal history of breast cancer in the FFDM group was significantly lower (P < 0.0001) than in the combination DBT plus FFDM group; 2.5% and 5.7%, respectively. A significant difference in family history of breast cancer (P < 0.0001) was found, with a higher rate in the combination DBT plus FFDM group (36.0% vs. 53.8%). There was a significant difference between the combination DBT plus FFDM group and FFDM alone group, when comparing breast density (P < 0.0147, 61.64% vs. 54.20% dense breasts, respectively) with a higher rate of dense breasts in the DBT plus FFDM group. In follow-up, one cancer was detected within one year of normal screening mammogram in the combination DBT plus FFDM group. Conclusion: Our initial experience found the recall rate in the combination DBT plus FFDM group was significantly lower than in the FFDM alone group, despite the fact that the combination DBT plus FFDM group had additional risk factors.

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Performance of Digital Breast Tomosynthesis, Synthetic Mammography and Digital Mammography in Breast Cancer Screening: A Systematic Review and Meta-Analysis

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djaa205 ◽

2020 ◽

Author(s):

Mostafa Alabousi ◽

Akshay Wadera ◽

Mohammed Kashif Al-Ghita ◽

Rayeh Kashef Al-Ghetaa ◽

Jean-Paul Salameh ◽

...

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Digital Mammography ◽

Statistical Tests ◽

Meta Analysis ◽

Digital Breast Tomosynthesis ◽

Recall Rate ◽

Breast Tomosynthesis

Abstract Background To perform a systematic review and meta-analysis comparing the breast cancer detection rate (CDR), invasive CDR, recall rate, and positive predictive value 1 (PPV1) of digital breast tomosynthesis (DBT), combined DBT and digital mammography (DM), combined DBT and synthetic 2 D-mammography (S2D), and DM alone. Methods MEDLINE and Embase were searched until April 2020 to identify comparative design studies reporting on patients undergoing routine breast cancer screening. Random effects model proportional meta-analyses estimated CDR, invasive CDR, recall rate, and PPV1. Meta-regression modeling was utilized to compare imaging modalities. All statistical tests were two-sided. Results Forty-two studies reporting on 2,606,296 patients (13,003 breast cancer cases) were included. CDR was highest in combined DBT and DM (6.36 per 1,000 screened, 95% confidence interval [CI]=5.62–7.14; P < .001), and combined DBT and S2D (7.40 per 1,000 screened, 95% CI = 6.49–8.37; P < .001) compared to DM alone (4.68 per 1,000 screened, 95% CI = 4.28–5.11). Invasive CDR was highest in combined DBT and DM (4.53 per 1,000 screened, 95% CI = 3.97–5.12, P = .003), and combined DBT and S2D (5.68 per 1,000 screened, 95% CI = 4.43–7.09; P < .001) compared to DM alone (3.42 per 1,000 screened, 95% CI = 3.02–3.83). Recall rate was lowest in combined DBT and S2D (42.3%, 95% CI = 37.4%–60.4%, P < .001). PPV1 was highest in combined DBT and DM (10.0%, 95% CI = 8.0–12.0; P = .004), and combined DBT and S2D (16.0%, 95% CI = 10.0–23.0; P < .001), while no difference was detected for DBT alone (7.0%, 95% CI = 6.0%–8.0%; P = .75) compared to DM alone (7.0%, 95.0% CI = 5.0%–8.0%). Conclusion Our findings provide evidence on key performance metrics for DM, DBT alone, combined DBT and DM, and combined DBT and S2D, which may inform optimal application of these modalities for breast cancer screening.

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