Digital breast tomosynthesis (DBT): recommendations from the Italian College of Breast Radiologists (ICBR) by the Italian Society of Medical Radiology (SIRM) and the Italian Group for Mammography Screening (GISMa)

Daniela Bernardi, Paolo Belli, Eva Benelli, Beniamino Brancato, Lauro Bucchi, Massimo Calabrese, Luca A Carbonaro, Francesca Caumo, Beatrice Cavallo-Marincola, Paola Clauser, Chiara Fedato, Alfonso Frigerio, Vania Galli, Livia Giordano, Paolo Giorgi Rossi, Paola Golinelli, Doralba Morrone, Giovanna Mariscotti, Laura Martincich, Stefania Montemezzi, Carlo Naldoni, Adriana Paduos, Pietro Panizza, Federica Pediconi, Fiammetta Querci, Antonio Rizzo, Gianni Saguatti, Alberto Tagliafico, Rubina M Trimboli, Marco Zappa, Chiara Zuiani, Francesco Sardanelli, Daniela Bernardi, Paolo Belli, Eva Benelli, Beniamino Brancato, Lauro Bucchi, Massimo Calabrese, Luca A Carbonaro, Francesca Caumo, Beatrice Cavallo-Marincola, Paola Clauser, Chiara Fedato, Alfonso Frigerio, Vania Galli, Livia Giordano, Paolo Giorgi Rossi, Paola Golinelli, Doralba Morrone, Giovanna Mariscotti, Laura Martincich, Stefania Montemezzi, Carlo Naldoni, Adriana Paduos, Pietro Panizza, Federica Pediconi, Fiammetta Querci, Antonio Rizzo, Gianni Saguatti, Alberto Tagliafico, Rubina M Trimboli, Marco Zappa, Chiara Zuiani, Francesco Sardanelli

Abstract

This position paper, issued by ICBR/SIRM and GISMa, summarizes the evidence on DBT and provides recommendations for its use. In the screening setting, DBT in adjunct to digital mammography (DM) increased detection rate by 0.5-2.7‰ and decreased false positives by 0.8-3.6% compared to DM alone in observational and double-testing experimental studies. The reduction in recall rate could be less prominent in those screening programs which already have low recall rates with DM. The increase in radiation exposure associated with DM/DBT protocols has been solved by the introduction of synthetic mammograms (sDM) reconstructed from DBT datasets. Thus, whenever possible, sDM/DBT should be preferred to DM/DBT. However, before introducing DBT as a routine screening tool for average-risk women, we should wait for the results of randomized controlled trials and for a statistically significant and clinically relevant reduction in the interval cancer rate, hopefully associated with a reduction in the advanced cancer rate. Otherwise, a potential for overdiagnosis and overtreatment cannot be excluded. Studies exploring this issue are ongoing. Screening of women at intermediate risk should follow the same recommendations, with particular protocols for women with previous BC history. In high-risk women, if mammography is performed as an adjunct to MRI or in the case of MRI contraindications, sDM/DBT protocols are suggested. Evidence exists in favor of DBT usage in women with clinical symptoms/signs and asymptomatic women with screen-detected findings recalled for work-up. The possibility to perform needle biopsy or localization under DBT guidance should be offered when DBT-only findings need characterization or surgery.

Keywords: Breast cancer; Digital breast tomosynthesis; Mammography; Screening.

Conflict of interest statement

Conflict of interest

The authors declare no funding and no conflict of interest for this article.

Ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.

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