46P 3D Digital Breast Tomosynthesis: Role in Recall Rate Reduction in Mammography Screening: An Initial Study on Asian Population

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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Increased Cancer Detection Rate and Variations in the Recall Rate Resulting from Implementation of 3D Digital Breast Tomosynthesis into a Population-based Screening Program

Radiology ◽

10.1148/radiol.2015142036 ◽

2016 ◽

Vol 278 (3) ◽

pp. 698-706 ◽

Cited By ~ 67

Author(s):

Richard E. Sharpe ◽

Shambavi Venkataraman ◽

Jordana Phillips ◽

Vandana Dialani ◽

Valerie J. Fein-Zachary ◽

...

Keyword(s):

Cancer Detection ◽

Detection Rate ◽

Screening Program ◽

Digital Breast Tomosynthesis ◽

Recall Rate ◽

Population Based ◽

Cancer Detection Rate ◽

Breast Tomosynthesis

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The screening value of mammography for breast cancer : an overview of 22 systematic reviews with evidence mapping (Preprint)

10.2196/preprints.29172 ◽

2021 ◽

Author(s):

Jiyuan Shi Jr ◽

Ya Gao Sr ◽

Peng Wang 2nd ◽

Liang Zhao ◽

Shuang Wu 4th ◽

...

Keyword(s):

Breast Cancer ◽

Systematic Reviews ◽

Mammography Screening ◽

Meta Analysis ◽

Breast Cancer Mortality ◽

Digital Breast Tomosynthesis ◽

Recall Rate ◽

Risk Of Bias ◽

Cochrane Library ◽

Evidence Mapping

UNSTRUCTURED Several meta-analyses have evaluated the screening value of mammography for breast cancer, but the overall results have remained mixed or inconclusive. Comprehensive literature search was conducted for SRs (systematic reviews) in Chinese Biomedical Databases (CBM), Cochrane Library, EMBASE, and PubMed until July 10, 2020. SRs with meta-analysis reported the benefit and performance of mammography screening were included. Two reviewers independently extracted data and performed the methodological quality assessments using The Risk Of Bias In Systematic Reviews (ROBIS). The characteristics of included SRs, the results of the quality of Risk of bias (RoBs) assessment and the pooled estimates of effect size were descriptively summarized using systematically structured tables and evidence mapping. Twenty two systematic reviews with meta-analysis were included. Only 13.6% of SRs were assessed as low-risk bias according to the overall risk of bias rating results in ROBIS tool. Pooled estimates for a reduction in breast cancer mortality attributable to mammography screening were range from 0.51 (OR, 95% CI: 0.46-0.55) to 1.04 (RR, 95% CI: 0.84-1.27). Sensitivity of difference mammography was ranged from 55% to 91%, specificity of difference mammography was ranged from 84% to 97%. According to the results of included SRs suggested, the statistically significant was observed that digital breast tomosynthesis (DBT) increased the cancer detected rate (CDR) and reduced the recall rate compared to digital mammography (DM), DM increased the CDR compared to screen-film mammography (SFM), and add DBT to digital or synthetic mammography increases the sensitivity, specificity, and CDR than DBT alone. Further study should investigate the value of different imaging technology in breast cancer screening.

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Diagnostic accuracy of digital breast tomosynthesis in combination with 2D mammography for the characterisation of mammographic abnormalities

Scientific Reports ◽

10.1038/s41598-020-77456-6 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Vithya Visalatchi Sanmugasiva ◽

Marlina Tanty Ramli Hamid ◽

Farhana Fadzli ◽

Faizatul Izza Rozalli ◽

Chai Hong Yeong ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Breast Imaging ◽

Digital Breast Tomosynthesis ◽

Asian Population ◽

Architectural Distortion ◽

Breast Lesions ◽

Cross Sectional ◽

Breast Tomosynthesis ◽

Full Field

AbstractThis study aims to assess the diagnostic accuracy of digital breast tomosynthesis in combination with full field digital mammography (DBT + FFDM) in the charaterisation of Breast Imaging-reporting and Data System (BI-RADS) category 3, 4 and 5 lesions. Retrospective cross-sectional study of 390 patients with BI-RADS 3, 4 and 5 mammography with available histopathology examination results were recruited from in a single center of a multi-ethnic Asian population. 2 readers independently reported the FFDM and DBT images and classified lesions detected (mass, calcifications, asymmetric density and architectural distortion) based on American College of Radiology-BI-RADS lexicon. Of the 390 patients recruited, 182 malignancies were reported. Positive predictive value (PPV) of cancer was 46.7%. The PPV in BI-RADS 4a, 4b, 4c and 5 were 6.0%, 38.3%, 68.9%, and 93.1%, respectively. Among all the cancers, 76% presented as masses, 4% as calcifications and 20% as asymmetry. An additional of 4% of cancers were detected on ultrasound. The sensitivity, specificity, PPV and NPV of mass lesions detected on DBT + FFDM were 93.8%, 85.1%, 88.8% and 91.5%, respectively. The PPV for calcification is 61.6% and asymmetry is 60.7%. 81.6% of cancer detected were invasive and 13.3% were in-situ type. Our study showed that DBT is proven to be an effective tool in the diagnosis and characterization of breast lesions and supports the current body of literature that states that integrating DBT to FFDM allows good characterization of breast lesions and accurate diagnosis of cancer.

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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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Benefits of digital breast tomosynthesis: A lesion-level analysis

Journal of Medical Screening ◽

10.1177/0969141320978267 ◽

2020 ◽

pp. 096914132097826

Author(s):

Tali Amir ◽

Emily B Ambinder ◽

Susan C Harvey ◽

Eniola T Oluyemi ◽

Mary K Jones ◽

...

Keyword(s):

Digital Breast Tomosynthesis ◽

Recall Rate ◽

Architectural Distortion ◽

Screening Mammogram ◽

Diagnostic Challenge ◽

Breast Tomosynthesis ◽

Full Field ◽

Lesion Type ◽

Lesion Level ◽

Screening Mammograms

Objective To compare outcome metrics of digital breast tomosynthesis (DBT) breast cancer screening with full-field digital mammogram (FFDM); specifically, to compare recall rates by the type of recalled finding, and to assess if screening with DBT versus FFDM changes biopsy recommendations and if the likelihood of malignancy varied by lesion type, if detected on DBT or FFDM screening mammogram. Methods The outcomes of 22,055 FFDM and DBT screening mammograms were retrospectively reviewed. The exams were performed at an academic institution between August 2015 and September 2016. Performance of screening with FFDM versus DBT was compared in terms of recall rate and percentage of recalled lesions resulting in a cancer diagnosis, with subset analyses performed for specific mammographic findings. Results The recall rate was 10.6% for FFDM and 8.0% for DBT ( p < 0.001). Architectural distortion was more likely to be recalled on DBT screening than FFDM ( p = 0.002), and was associated with an increased likelihood of malignancy ( p = 0.008). Asymmetries were less likely to be recalled on DBT than FFDM ( p < 0.001) screening mammogram, but more likely to be recommended for biopsy when detected on DBT. Calcifications more frequently required short-term follow-up or biopsy on both DBT and FFDM. Conclusions DBT screening confers an advantage in detection of architectural distortion representing malignancy. Recall rate of asymmetries are reduced with screening DBT, probably due to reduction of tissue superimposition. Calcifications pose a particularly difficult diagnostic challenge for breast imagers, regardless of screening mammogram type.

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Screening Digital Breast Tomosynthesis: Radiation Dose Among Patients With Breast Implants

Journal of Breast Imaging ◽

10.1093/jbi/wbab073 ◽

2021 ◽

Author(s):

Nhu Q Vu ◽

Curran Bice ◽

John Garrett ◽

Colin Longhurst ◽

Daryn Belden ◽

...

Keyword(s):

Radiation Dose ◽

Cancer Detection ◽

Digital Breast Tomosynthesis ◽

Breast Implants ◽

Recall Rate ◽

Screening Mammography ◽

Chi Square ◽

Breast Tomosynthesis ◽

Full Field ◽

Significant Difference

Abstract Objective To compare the mean glandular dose (MGD), cancer detection rate (CDR), and recall rate (RR) among screening examinations of patients with breast implants utilizing various digital breast tomosynthesis (DBT)-based imaging protocols. Methods This IRB-approved retrospective study included 1998 women with breast implants who presented for screening mammography between December 10, 2013 and May 29, 2020. Images were obtained using various protocol combinations of DBT and 2D digital mammography. Data collected included MGD, implant type and position, breast density, BI-RADS final assessment category, CDR, and RR. Statistical analysis utilized type II analysis of variance and the chi-square test. Results The highest MGD was observed in the DBT only protocol, while the 2D only protocol had the lowest (10.29 mGy vs 5.88 mGy, respectively). Statistically significant difference in MGD was observed across protocols (P < 0.0001). The highest per-view MGD was among DBT full-field (FF) views in both craniocaudal and mediolateral oblique projections (P < 0.0001). No significant difference was observed in RR among protocols (P = 0.17). The combined 2D (FF only) + DBT implant-displaced (ID) views protocol detected the highest number of cancers (CDR, 7.2 per 1000), but this was not significantly different across protocols (P = 0.48). Conclusion The combination of 2D FF views and DBT ID views should be considered for women with breast implants in a DBT-based screening practice when aiming to minimize radiation exposure without compromising the sensitivity of cancer detection. Avoidance of DBT FF in this patient population is recommended to minimize radiation dose.

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