Advertisement

Comparison of Resource Utilization and Clinical Outcomes Following Screening with Digital Breast Tomosynthesis Versus Digital Mammography: Findings From a Learning Health System

      Rationale and Objectives

      To compare outcomes associated with breast cancer screening with digital mammography (DM) alone versus in combination with digital breast tomosynthesis (DBT) in a large representative cohort.

      Materials and Methods

      A total of 325,729 screening mammograms from 247,431 women were analyzed, across two healthcare systems, from June 2015 to September 2017. Patient level demographic, calculated risk levels, and clinical outcomes were extracted from radiology information system and electronic medical records. Multivariable regression modeling adjusting for institution, age, breast density, and first exam was conducted to compare patient characteristics, recall rates, time to biopsy and final diagnosis, clinical outcomes, and diagnostic performance. Participating institutions and the Coordinating Center received Institutional Review Board approval for a waiver of consent to collect and link data and perform analysis.

      Results

      A total of 194,437 (59.7%) screens were DBT versus 131,292 (40.3%) with DM. Women with dense breasts and higher calculated risk were more likely to be screened with DBT. Recall rates were lower for DBT overall (8.83% DBT vs 10.98% DM, adjusted odds ratio, 95% confidence interval = 0.85, 0.83–0.87) and across all age groups, races, and breast densities, and at facilities that used predominantly DBT (8.05%) versus predominantly DM (11.22%), or a combination (10.73%). The most common diagnostic pathway after recall was mammography and ultrasound. Women recalled from DBT were more likely to proceed directly to ultrasound. The median time to biopsy (18 vs 22 days) and final diagnosis (10 vs 13 days) was shorter for DBT. The adjusted cancer rate, cancer detection rate, and specificity were higher for DBT.

      Conclusion

      DBT demonstrated a more efficient screening pathway and improved quality measures with lower recall rates in all patient types, reduced diagnostic mammography and shorter time to biopsy and final diagnosis.

      Key Words

      Abbreviations:

      AHC (Advocate Health Care), BI-RADS (American College of Radiology's Breast Imaging Reporting and Data System), CI (confidence interval), DBT (digital breast tomosynthesis), DB (digital mammography), HER2 (human epidermal growth factor receptor 2), IQR (interquartile range), OR (odds ratio), PPV1 (“positive predictive value 1”—the number of cancers detected per number of positive screens), PPV 3 (“positive predictive value 3”—the number of cancers diagnosed per number of biopsies performed), RIS (radiology information system), UPHS (University of Pennsylvania Health System)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Breast Cancer Facts and Figures 2017-2018 Atlanta: American Cancer Society; 2017 [cited 2018]. Available from: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2017-2018.pdf.

        • Miller JD
        • Bonafede MM
        • Herschorn SD
        • et al.
        Value Analysis of digital breast tomosynthesis for breast cancer screening in a US medicaid population.
        J Am Coll Radiol. 2017; 14: 467-474
        • Marmot MG
        • Altman DG
        • Cameron DA
        • et al.
        The benefits and harms of breast cancer screening: an independent review: a report jointly commissioned by Cancer Research UK and the Department of Health (England) October 2012.
        Br J Cancer. 2013; 108: 2205-2240
        • Coldman A
        • Phillips N
        • Wilson C
        • et al.
        Pan-Canadian study of mammography screening and mortality from breast cancer.
        JNCI. 2014; 106 (Available at:)
        • Bernardi D
        • Macaskill P
        • Pellegrini M
        • et al.
        Breast cancer screening with tomosynthesis (3D mammography) with acquired or synthetic 2D mammography compared with 2D mammography alone (STORM-2): a population-based prospective study.
        Lancet Oncol. 2016; 17: 1105-1113
        • Conant EF
        • Beaber EF
        • Sprague BL
        • et al.
        Breast cancer screening using tomosynthesis in combination with digital mammography compared to digital mammography alone: a cohort study within the PROSPR consortium.
        Breast Cancer Res Treat. 2016; 156: 109-116
        • Friedewald SM
        • Rafferty EA
        • Rose SL
        • et al.
        Breast cancer screening using tomosynthesis in combination with digital mammography.
        JAMA. 2014; 311: 2499
        • Sickles EA
        • D'Orsi CJ
        How should screening breast US be audited? The BI-RADS perspective.
        Radiology. 2014; 272: 316-320
        • Conant EF
        • Beaber EF
        • Sprague BL
        • et al.
        Breast cancer screening using tomosynthesis in combination with digital mammography compared to digital mammography alone: a cohort study within the PROSPR consortium.
        Breast Cancer Res Treat. 2016; 156: 109
        • Lourenco AP
        • Barry-Brooks M
        • Baird GL
        • et al.
        Changes in recall type and patient treatment following implementation of screening digital breast tomosynthesis.
        Radiology. 2015; 274: 337
        • Raghu M
        • Durand MA
        • Andrejeva L
        • et al.
        Tomosynthesis in the diagnostic setting: changing rates of BI-RADS final assessment over time.
        Radiology. 2016; 281: 54
        • Kim JY
        • Kang HJ
        • Shin JK
        • et al.
        Biologic profiles of invasive breast cancers detected only with digital breast tomosynthesis.
        Am J Roentgenol. 2017; 209: 1411-1418