Breast tomosynthesis reduces recalls, could soon replace routine 2D mammography
Digital breast tomosynthesis (DBT) systems now make up 48% of mammography systems in the U.S. and will likely surpass 50% in the next year, according to recent U.S. Food and Drug Administration (FDA) data. Breast imaging experts say this will help reduce the overall number of patient recalls by cutting down on false positives.
"Tomo is going to replace just straight digital mammography simply because of the benefit of fewer recalls," Debra L. Monticciolo, MD, FACR, FSBI, past-president of both the Society of Breast Imaging (SBI), and the American College of Radiology (ACR), explained during an interview with Health Imaging.
She said studies have shown DBT will decrease the number of recalls. But, she said some studies have shown the cancer detection rate increases with DBT. This is because the radiologist can scroll through the layers of breast tissue to see if suspicious areas are just areas of overlapping dense tissue or a cancer. This can be much harder to detect on 2D mammograms in women with dense breasts.
"I think we've gotten kind of to the limit of what we can do with morphologic screening. Mammography does have limitations, especially in women with heterogeneously dense and dense breasts. So currently that's where all the research is going," she suggested.
She said women who do not have dense breasts will do fine with standard 2D digital mammography. The FDA says that 90% of women's imaging centers in the U.S. now have at least one DBT system for women with dense breasts, and that number continues to climb.
But, she reiterates morphologic screening has its limits, so further enhances to screening are needed. This may include contrast enhanced mammography, artificial intelligence (AI) tools to pull additional data from exams, and tomosynthesis-guided biopsy.
Monticciolo said AI will likely play a growing role in breast cancer screenings and supplemental exams, including breast MRI, to try and identify cancers at the earliest possible stage when they are easiest to treat.
"Mammography is still the mainstay because it's so accessible and it's affordable, so there's a lot of positives, but we know it does have limitations," Monticciolo explained.
She offers an overview of the past decade of DBT in this 2023 article in the Journal of the American College of Radiology.
See additional interviews with Monticciolo:
• The pros and cons of current breast screening modalities and the role of AI
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com