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Digital Tomosynthesis Reduces Mammography Recall Rate

March 17, 2009
Written by: , Filed in: Breast Imaging
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Digital Tomosynthesis Reduces Mammography Recall Rate

A recent study evaluated the potential role of digital breast tomosynthesis in diagnostic mammography, and compared digital breast tomosynthesis versus film-screen mammography in a diagnostic mammography setting.

The results, published in AJR, indicate that digital tomosynthesis reduces the mammography recall rate.

The Study
The study included 98 women who had abnormal findings on digital screening mammography.

Methodology

Subsequently, digital tomosynthesis and film-screen diagnostic mammography were performed on these women.

The results of the two modalities and the results of ultrasound, MRI, and biopsy were reviewed.

Tomosynthesis acquisition included 11 low-dose X-ray exposures with the total radiation dose per acquisition being 400 mrem (4mSv). These images were reconstructed into 1-mm-thick slices for review by radiologists.

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Related CME

Women's Imaging
University of California San Francisco, Department of Radiology

  The overall goal of this program is to provide current information on the relevant use of imaging and interventional techniques in women with breast and gynecologic pathology. Core concepts and future directions are addressed, including cancer screening, breast intervention, and current status of breast and gynecologic MRI. Up to 20.75 AMA PRA Category 1 Credit(s)™ are available.
Read more or order: Women's Imaging

Imaging Review: Body, Bone & Breast
University of California, San Francisco, Department of Radiology
  This program is designed for the radiologist in clinical practice, and is intended to provide an overview and update on clinically relevant topics in diagnostic imaging, as well as an up-to-date assessment of the clinical uses of modern imaging modalities such as CT, MR and ultrasound. 20 AMA PRA Category 1 Credit(s)™ are available.
  Read more or order: Imaging Review: Body, Bone & Breast

Results
In most cases, the image quality of tomosynthesis was rated as equal or superior to that of film-screen mammography by the radiologists in the study.

The use of tomosynthesis generated an additional eight recalls and discarded a significant number of original recalls such that the recall rate was reduced by 40%.

The reduction in the recall rate was mostly due to identifying initial findings (such as asymmetry, focal asymmetry, and questionable architectural distortion) as summation of tissue on tomosynthesis.
Tomosynthesis and film-screen mammography detected the same number of cancers in the study.

Conclusions

Digital tomosynthesis may offer superior image quality and may have a potential role in reducing the recall rate of screening mammography.

Reviewer’s Comments
The clinical applications of full-field digital mammography have allowed radiologists to investigate digital tomosynthesis as an alternative approach to traditional mammography.

In most breast imaging practices, approximately 10% of screening mammography patients are recalled for an additional diagnostic mammographic workup and/or ultrasound.

Often, additional mammographic views performed during the diagnostic workup reveal that original abnormal findings simply represent summation of breast tissue.

Although the study has several limitations, its results suggest that digital breast tomosynthesis may have a potential role in reducing the recall rate of screening mammography and, therefore, reducing the false-positive rate of mammography.

A large prospective double-blind study using both digital tomosynthesis and full-field digital mammography with a longer follow-up period is needed before digital tomosynthesis can be incorporated into clinical breast imaging practices.

Author: Bokran Won, MD
Reference:
Poplack, Steven P., Tosteson, Tor D., Kogel, Christine A. and Nagy, Helene M. Digital Breast Tomosynthesis: Initial Experience in 98 Women with Abnormal Digital Screening Mammography. AJR 2007; 189:616-623

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Related CME

Women's Imaging
University of California San Francisco, Department of Radiology

  The overall goal of this program is to provide current information on the relevant use of imaging and interventional techniques in women with breast and gynecologic pathology. Core concepts and future directions are addressed, including cancer screening, breast intervention, and current status of breast and gynecologic MRI. Up to 20.75 AMA PRA Category 1 Credit(s)™ are available.
Read more or order: Women's Imaging

Imaging Review: Body, Bone & Breast
University of California, San Francisco, Department of Radiology
  This program is designed for the radiologist in clinical practice, and is intended to provide an overview and update on clinically relevant topics in diagnostic imaging, as well as an up-to-date assessment of the clinical uses of modern imaging modalities such as CT, MR and ultrasound. 20 AMA PRA Category 1 Credit(s)™ are available.
  Read more or order: Imaging Review: Body, Bone & Breast
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