Advertisement

Breast Cancer Research and Treatment

, Volume 133, Issue 1, pp 267–271 | Cite as

Prospective study of breast tomosynthesis as a triage to assessment in screening

  • Daniela Bernardi
  • Stefano Ciatto
  • Marco Pellegrini
  • Paolina Tuttobene
  • Carmine Fanto’
  • Marvi Valentini
  • Stefano Di Michele
  • Paolo Peterlongo
  • Nehmat Houssami
Clinical trial

Abstract

There is limited evidence on the role of 3D mammography with tomosynthesis in breast screening, although early studies suggest that it may improve specificity. We prospectively evaluated the effect of integrating 3D mammography as a triage to assessment in 158 consecutive recalls to assessment (recalled in standard 2D-mammographic screening) in asymptomatic subjects. Radiologists provided 3D mammography-based opinion as to whether recall/assessment was warranted or unnecessary, and all subjects proceeded to assessment. 3D triage was positive (confirmed the need for assessment) in all 21 subjects with breast cancer (there were no false negatives), and would have avoided recall in 102 of 137 (74.4%) subjects with a negative/benign final outcome in whom 3D triage did not recommend recall. Proportion of true negative 3D triage (as a proxy for potential reduction in recalls) was slightly higher in dense than non-dense breasts, did not differ across age-groups, but was significantly associated with the type of lesion seen on imaging (being highest for distortions, asymmetric densities, and lesions with ill-defined margins). While the simulation design may have over-estimated the potential for 3D mammography triage to reduce recalls, this study clearly demonstrates its capability to improve breast screening specificity and to reduce recall rates. Future studies of 3D mammography should further assess its role as a recall-reducing strategy in screening practice and should include formal cost-analysis.

Keywords

Breast carcinoma Diagnosis Screening Mammography Tomosynthesis Recall rate 

Notes

Aknowledgment

Dr Houssami is supported by the National Health and Medical Research Council program grant 633003 to the Screening and Test Evaluation Program.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The study design complies with the current Italian laws.

References

  1. 1.
    Glasziou P, Houssami N (2011) The evidence base for breast cancer screening. Prev Med [Epud ahead of print]. doi: 10.1016/j.ypmed.2011.05.011
  2. 2.
    Kerlikowske K, Grady D, Rubin SM, Sandrock C, Ernster VL (1995) Efficacy of screening mammography. A meta-analysis. J Am Med Assoc 273:149–154CrossRefGoogle Scholar
  3. 3.
    Laya MB, Larson EB, Taplin SH et al (1996) Effect of estrogen replacement therapy on the specificity and sensitivity of screening mammography. J Natl Cancer Inst 88:643–649PubMedCrossRefGoogle Scholar
  4. 4.
    Lehman CD, White E, Peacock S et al (1999) Effect of age and breast density on screening mammograms with false positive findings. Am J Roentgenol 173:1651–1655Google Scholar
  5. 5.
    Brewer NT, Salz T, Lillie SE (2007) Systematic review: the long-term effects of false-positive mammograms. Ann Intern Med 146:502–510PubMedGoogle Scholar
  6. 6.
    Giordano L, Giorgi D, Piccini P, Ventura L, Stefanini V, Senore C, Paci E, Segnan N (2008) Time trends of process and impact indicators in Italian breast screening programmes-1996–2005. Epidemiol Prev 32:23–36PubMedGoogle Scholar
  7. 7.
    The National centre for Screening Monitoring: Eighth Report. http://win.osservatorionazionalescreening.it/eng-publications.php. Accessed 10 Oct 2011
  8. 8.
    Australian Institute of Health and Welfare (2009) BreastScreen Australia monitoring report 2005–2006. Cancer series no. 48. Cat. no. CAN 44. Canberra: AIHW. http://www.aihw.gov.au. Accessed 10 Oct 2011
  9. 9.
    Zappa M, Spagnolo G, Ciatto S, Giorgi D, Paci E, Rosselli Del Turco M (1995) Measurement of the costs in two mammographic screening programmes in the province of Florence, Italy. J Med Screen 2:191–194PubMedGoogle Scholar
  10. 10.
    Park JM, Franken EA Jr, Garg M et al (2007) Breast tomosynthesis: present considerations and future applications. Radiographics 27:S231–S240PubMedCrossRefGoogle Scholar
  11. 11.
    Niklason LT, Christian BT, Niklason LE et al (1997) Digital breast tomosynthesis in breast imaging. Radiology 205:25–31Google Scholar
  12. 12.
    Rafferty EA, Georgian-Smith D, Kopans DB et al (2002) Comparison of full-field digital tomosynthesis with two view conventional film screen mammography in the prediction of lesion malignancy. Radiology 225:268Google Scholar
  13. 13.
    Teertstra HJ, Loo CE, van den Bosch MA et al (2010) Breast tomosynthesis in clinical practice: initial results. Eur Radiol 20:16–24PubMedCrossRefGoogle Scholar
  14. 14.
    Mitka M (2008) New screening methods offer hope for more accurate breast cancer detection. J Am Med Assoc 299:397–398CrossRefGoogle Scholar
  15. 15.
    Gur D (2007) Tomosynthesis: potential clinical role in breast imaging. Am J Roentgenol 189:614–615CrossRefGoogle Scholar
  16. 16.
    Poplack SP, Tosteson TD, Kogel CA, Nagy HM (2007) Digital breast tomosynthesis: initial experience in 98 women with abnormal digital screening mammography. Am J Roentgenol 189:616–623CrossRefGoogle Scholar
  17. 17.
    Gur D, Abrams GS, Chough DM et al (2009) Digital breast tomosynthesis: observer performance study. Am J Roentgenol 193:586–591CrossRefGoogle Scholar
  18. 18.
    Pellegrini M, Bernardi D, Di Michele S et al (2011) Analysis of proportional incidence and review of interval cancer cases observed within the mammography screening programme in Trento province, Italy. Radiol Med 116(8):1217–1225PubMedCrossRefGoogle Scholar
  19. 19.
    Andersson I, Ikeda D, Zackrisson S et al (2008) Breast tomosynthesis and digital mammography: a comparison of breast cancer visibility and BIRADS classification in a population of cancers with subtle mammographic findings. Eur Rad 18:2817–2825CrossRefGoogle Scholar
  20. 20.
    Rafferty EA, Smith AP, Niklason, LT (2009) Assessing radiologist performance in dense versus fatty breasts using combined full-field digital mammography and breast tomosynthesis compared to full-field digital mammography alone. Radiologic Society of North America 95th Scientific Assembly and Annual Meeting; Chicago, ILGoogle Scholar
  21. 21.
    Moore RH, Boston MA, Kopans DB, et al (2007) Initial callback rates for conventional and digital breast tomosynthesis mammography comparison in the screening setting. Radiologic Society of North America 92nd Scientific Assembly and Annual Meeting; Chicago, ILGoogle Scholar
  22. 22.
    Caumo F, Brunelli S, Tosi E et al (2011) On the role of arbitration of discordant double readings of screening mammography: experience from two Italian programmes. Radiol Med 116:84–91PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2012

Authors and Affiliations

  • Daniela Bernardi
    • 1
  • Stefano Ciatto
    • 1
  • Marco Pellegrini
    • 1
  • Paolina Tuttobene
    • 1
  • Carmine Fanto’
    • 1
  • Marvi Valentini
    • 1
  • Stefano Di Michele
    • 1
  • Paolo Peterlongo
    • 1
  • Nehmat Houssami
    • 2
  1. 1.U.O. Senologia Clinica e Screening Mammografico, Dipartimento di RadiodiagnosticaAPSSTrentoItaly
  2. 2.Screening and Test Evaluation Program, School of Public Health, Sydney Medical SchoolUniversity of SydneySydneyAustralia

Personalised recommendations