Initial experience with combination digital breast tomosynthesis plus full field digital mammography or full field digital mammography alone in the screening environment

Stamatia Destounis, Andrea Arieno, Renee Morgan, Stamatia Destounis, Andrea Arieno, Renee Morgan

Abstract

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 χ(2) (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.

Keywords: Breast imaging; digital breast tomosynthesis; screening mammography.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
42-year-old asymptomatic woman presents for routine screening with combination digital breast tomosynthesis plus full field digital mammography (a) Full field digital mammography craniocaudal view demonstrates a possible area of architectural distortion (arrow). (b) Digital breast tomosynthesis slice demonstrates the area of architectural distortion more definitively (arrow). Biopsy result was invasive ductal carcinoma.
Figure 2
Figure 2
Total examinations interpreted per reader.
Figure 3
Figure 3
Comparison of recall rates per reader for full field digital mammography and digital breast tomosynthesis during the study period. *Reader 5 had 1 year of experience with mammography and digital breast tomosynthesis (DBT) at the time of this review. Reader 6 had the least amount of experience with DBT.

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