More evidence tomosynthesis cuts recall rates; improves breast cancer detection

Combining digital breast tomosynthesis (DBT) with full field digital mammography (FFDM) cut recall rates by 35 percent and dramatically improved breast cancer detection, according to a recent study.

Authors Stephen L. Rose, MD, of Houston-based Rose Imaging Specialists, and colleagues wrote that the recall rate in their study was 5.41 percent for screening using DBT together with FFDM, for 10,878 examinations, but that it was 8.6 percent when using FFDM alone.

This study, published in the September issue of Academic Radiology, is the latest one to find that the use of tomosynthesis cuts recall rates.

Other studies have come to the same conclusion, reporting recall rate cuts of between 30 percent and 60 percent, the authors noted.

“The use of DBT in the screening environment has a fundamental and significant impact on performance and this study represents one additional point of evidence in support of that effect,” they wrote.

DBT enables the reconstruction of cross-sectional images and provides better visualization of breast tissue, explained Rose and colleagues.

The study found that the rate of invasive breast cancer detection was 66 percent higher when using DBT together with FFDM than when using only FFDM. The rate of suspicious abnormalities later found to be cancer was 55 percent higher.

The authors pointed out ongoing challenges in breast imaging, including the “relatively low cancer detection rate” or mammograms. For example, 95 percent of recalled abnormalities for mammography readings are negative, the said.

Another challenge is the large variability in performance levels among radiologists who interpret mammograms, they said.

The practice of the “single reader approach” used in the U.S. makes the task of mammogram interpretation more difficult, the authors wrote, while the practice in Europe of double reading, routinely followed by a consensus decision, makes it easier, they said.

“The process (in the U.S.) that leads to the decision of whether to recall a patient is more difficult to perform in a prospective manner,” they wrote.

During the study, 10 radiologists interpreted prospectively 10,878 DBT plus FFDM screening mammograms, while seven radiologists retrospectively interpreted the 10,878 corresponding FFDM examinations alone.