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
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References
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.
- Value Analysis of digital breast tomosynthesis for breast cancer screening in a US medicaid population.J Am Coll Radiol. 2017; 14: 467-474
- 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
- Pan-Canadian study of mammography screening and mortality from breast cancer.JNCI. 2014; 106 (Available at:)
- 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
- 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
- Breast cancer screening using tomosynthesis in combination with digital mammography.JAMA. 2014; 311: 2499
- How should screening breast US be audited? The BI-RADS perspective.Radiology. 2014; 272: 316-320
- 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
- Changes in recall type and patient treatment following implementation of screening digital breast tomosynthesis.Radiology. 2015; 274: 337
- Tomosynthesis in the diagnostic setting: changing rates of BI-RADS final assessment over time.Radiology. 2016; 281: 54
- Biologic profiles of invasive breast cancers detected only with digital breast tomosynthesis.Am J Roentgenol. 2017; 209: 1411-1418
Article info
Publication history
Published online: July 26, 2018
Accepted:
May 30,
2018
Received in revised form:
May 29,
2018
Received:
May 3,
2018
Footnotes
☆Acknowledgments: This study was supported by Hologic Inc., Marlborough, Massachusetts
✰✰Declaration of Interest: Nila H. Alsheik MD—employee of Advocate Health and is also on Hologic's scientific advisory panel; Firas Dabbous PhD—employee of Advocate Health; Scott K. Pohlman—employee of Hologic Inc.; Kathleen M. Troeger—employee of Hologic Inc.; Richard E. Gliklich MD—employee of OM1 Inc.; Gregory M. Donadio—employee of OM1 Inc.; Zhaohui Su PhD—employee of OM1 Inc.; Vandana Menon MD PhD—employee of OM1 Inc.; Emily F. Conant MD—has grant from Hologic and is also on their scientific advisory panel.
Identification
Copyright
© 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
