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

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.

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Tomosynthesis-Guided Core Biopsy of the Breast: Why and How to Use it

Journal of Clinical Imaging Science ◽

10.4103/jcis.jcis_10_18 ◽

2018 ◽

Vol 8 ◽

pp. 28 ◽

Cited By ~ 3

Author(s):

Kyungmin Shin ◽

Davis Teichgraeber ◽

Sarah Martaindale ◽

Gary J Whitman

Keyword(s):

Cancer Detection ◽

Core Biopsy ◽

Breast Imaging ◽

Detection Rate ◽

Clinical Symptoms ◽

Digital Breast Tomosynthesis ◽

Screening Mammography ◽

Cancer Detection Rate ◽

Breast Tomosynthesis

Digital breast tomosynthesis (DBT) has become an important tool in breast imaging. It decreases the call-back rate while increasing the cancer detection rate on screening mammography and is useful for diagnostic examination of noncalcified lesions and for the evaluation of patients presenting with clinical symptoms. Management challenges and dilemmas that are encountered with abnormalities detected on DBT and lacking a sonographic correlate can now be addressed with tomosynthesis-guided core biopsy.

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Independent Double Reading of Screening Mammograms

Journal of Medical Screening ◽

10.1177/096914139500200209 ◽

1995 ◽

Vol 2 (2) ◽

pp. 99-101 ◽

Cited By ~ 49

Author(s):

Stefano Ciatto ◽

Marco Rosselli Del Turco ◽

Doralba Morrone ◽

Sandra Catarzi ◽

Daniela Ambrogetti ◽

...

Keyword(s):

Cancer Detection ◽

Detection Rate ◽

Recall Rate ◽

Cancer Detection Rate ◽

Diagnostic Assessment ◽

Double Reading ◽

Single Reading ◽

The Mean ◽

Screening Mammograms ◽

The Cost

Objective — To evaluate the cost effectiveness of independent double reading of screening mammograms. Setting — Prospective study of 18817 women undergoing first or repeat screening in a population based programme in the Florence district. Methods — Mammograms were independently double read by experienced radiologists. Subjects with mammographic abnormalities reported by at least one reader were recalled for diagnostic assessment. The mean increase in recall rate, cancer detection rate, and screening costs attributable to double reading was calculated. Results — Eleven of 125 cancers were detected by only one reader. The mean increase in cancer detection rate attributable to double reading compared with single reading was 4·6% (95% confidence interval (CI) 1·1 to 8·9). From a total of 748 cases referred for diagnostic assessment, 196 subjects were referred by one reader only. The mean increase in referral rate attributable to double reading compared with single reading was 15·1% (CI 12·3 to 17·8). Double reading caused a marked increase in the cost for each woman screened −8·5% at the first screening and 6·2% at repeat screening and a more limited increase in the cost for each cancer detected −3·5% at the first screening and 2·7% at repeat screening. Cancers detected by only one screener were at an earlier stage than those detected by both screeners (P = 0·6, not significant). Conclusions — Independent double reading results in only a modest increase in the detection of cancers and therefore may not be cost effective.

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Screening outcome for consecutive examinations with digital breast tomosynthesis versus standard digital mammography in a population-based screening program

European Radiology ◽

10.1007/s00330-019-06264-y ◽

2019 ◽

Vol 29 (12) ◽

pp. 6991-6999 ◽

Cited By ~ 3

Author(s):

Tone Hovda ◽

Siri H. B. Brandal ◽

Sofie Sebuødegård ◽

Åsne S. Holen ◽

Hilde Bjørndal ◽

...

Keyword(s):

Digital Mammography ◽

Screening Program ◽

Digital Breast Tomosynthesis ◽

Population Based ◽

Breast Tomosynthesis

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Implementation of Synthesized Two-dimensional Mammography in a Population-based Digital Breast Tomosynthesis Screening Program

Radiology ◽

10.1148/radiol.2016160366 ◽

2016 ◽

Vol 281 (3) ◽

pp. 730-736 ◽

Cited By ~ 78

Author(s):

Samantha P. Zuckerman ◽

Emily F. Conant ◽

Brad M. Keller ◽

Andrew D. A. Maidment ◽

Bruno Barufaldi ◽

...

Keyword(s):

Screening Program ◽

Digital Breast Tomosynthesis ◽

Population Based ◽

Two Dimensional ◽

Breast Tomosynthesis

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Mammographic findings of women recalled for diagnostic work-up in digital versus screen-film mammography in a population-based screening program

Acta Radiologica ◽

10.3109/02841851003691961 ◽

2010 ◽

Vol 51 (5) ◽

pp. 491-497 ◽

Cited By ~ 13

Author(s):

Seppo Lipasti ◽

Ahti Anttila ◽

Martti Pamilo

Keyword(s):

Cancer Detection ◽

Detection Rate ◽

Population Based ◽

Cancer Detection Rate ◽

Common Finding ◽

Radiological Findings ◽

Predictive Values ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up

Background: Limited information is available concerning differences in the radiological findings of women recalled for diagnostic work-up in digital mammography (DM) versus screen-film mammography (SFM) screening. Purpose: To compare the radiological findings, their positive predictive values (PPVs) for cancer and other process indicators of DM screening performed by computed radiography (CR) technology and SFM screening in a population-based program. Material and Methods: The material consisted of women, 50–59 years of age, who were invited for screening: 30 153 women with DM in 2007–2008 and 32 939 women with SFM in 1999–2000. The attendance rate was 77.7% (23 440) in the DM arm and 83.8% (27 593) in the SFM arm. In the DM arm, 1.71% of those screened (401) and in the SFM arm 1.59% (438) were recalled for further work-up. The images resulting in the recall were classified as: 1) tumor-like mass, 2) parenchymal distortion/asymmetry, 3) calcifications, and 4) combination of mass and calcifications. The distributions of the various radiological findings and their PPVs for cancer were compared in both study groups. The recall rates, cancer detection rates, test specificities, and PPVs of the DM and SFM groups were also compared. Results: Women were recalled for diagnostic work-up most often due to tumor-like mass. It was more common in SFM (1.08% per woman screened) than in DM (0.93%). The second most common finding was parenchymal distortion and asymmetry, more often in DM (0.58%) than in SFM (0.37%). Calcifications were the third most common finding. DM exposed calcifications more often (0.49%) than SFM (0.26%). The PPVs for cancer of the recalls were higher in DM than in SFM in all subgroups of radiological findings. The test specificities were similar (DM 98.9%, SFM 98.8%). Significantly more cancers were detected by DM (cancer detection rate 0.623% per woman screened, n=146) than by SFM (cancer detection rate 0.406% per woman screened, n=112). The PPVs for cancer of all recalls for diagnostic work-up were significantly higher in DM (36%) than in SFM (26%). Conclusion: In DM women were recalled for diagnostic work-up more often for calcifications, parenchymal distortions, and asymmetries than in SFM. In the case of tumor-like masses, more women were recalled in SFM. DM detected more cancers than SFM, and the PPVs for cancer were higher in DM than in SFM in all subgroups of radiological findings.

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Validity of process indicators of screening for breast cancer to predict mortality reduction

Journal of Medical Screening ◽

10.1258/0969141053279112 ◽

2005 ◽

Vol 12 (1) ◽

pp. 33-37 ◽

Cited By ~ 14

Author(s):

T Sarkeala ◽

A Anttila ◽

I Saarenmaa ◽

M Hakama

Keyword(s):

Breast Cancer ◽

European Community ◽

Cancer Detection ◽

Detection Rate ◽

Randomized Trials ◽

Recall Rate ◽

Cancer Detection Rate ◽

Process Indicators ◽

The Mean ◽

Mean Compliance

The aim of the study was to empirically assess the acceptable levels of process indicators as described in the European Community Guidelines using materials from the mammography service screening programmes. The Finnish programme was evaluated for effectiveness with a prior estimateof 0.74 for RR in Finland and 0.81 in Helsinki. Hence, the Finnish programme was likely to be somewhat less effective in terms of reduction in mortality than implied on the basis of early randomized trials, but probably approaching the same level of effectiveness. Finland therefore providesbackground data on the applicability of the process indicators that are indicators of performance and surrogates for effectiveness. The performance data on 10 Finnish screening centres at subsequent screens were used. These centres invited 687,000 women aged 50–64 years in 1991–2000.The mean compliance was 93% and the corresponding recall rate was 2.3%. The benign to malignant biopsy ratio was 0.43:1. The average breast cancer detection rate was 0.36%, 2.1 compared with the background incidence. The proportion of screen-detected stage II+ cancers was 26%. Most, but notall, of these process indicators met the desirable reference values of the European Community. The specific criteria of the European Community on stage distribution, rates of screen-detected cancers by stage and detection rate to background incidence may need reconsideration.

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