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Performance of breast cancer screening using digital breast tomosynthesis: results from the prospective population-based Oslo Tomosynthesis Screening Trial

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Abstract

Purpose

Digital breast tomosynthesis (DBT) has the potential to overcome limitations of conventional mammography. This study investigated the effects of addition of DBT on interval and detected cancers in population-based screening.

Methods

Oslo Tomosynthesis Screening Trial (OTST) was a prospective, independent double-reading trial inviting women 50–69 years biennially, comparing full-field digital mammography (FFDM) plus DBT with FFDM alone. Performance indicators and characteristics of screen-detected and interval cancers were compared with two previous FFDM rounds.

Results

24,301 consenting women underwent FFDM + DBT screening over a 2-year period. Results were compared with 59,877 FFDM examinations during prior rounds. Addition of DBT resulted in a non-significant increase in sensitivity (76.2%, 378/496, vs. 80.8%, 227/281, p = 0.151) and a significant increase in specificity (96.4%, 57229/59381 vs. 97.5%, 23427/24020, p < .001). Number of recalls per screen-detected cancer decreased from 6.7 (2530/378) to 3.6 (820/227) with DBT (p < .001). Cancer detection per 1000 women screened increased (6.3, 378/59877, vs. 9.3, 227/24301, p < .001). Interval cancer rate per 1000 screens for FFDM + DBT remained similar to previous FFDM rounds (2.1, 51/24301 vs. 2.0, 118/59877, p = 0.734). Interval cancers post-DBT were comparable to prior rounds but significantly different in size, grade, and node status from cancers detected only using DBT. 39.6% (19/48) of interval cancers had positive nodes compared with only 3.9% (2/51) of additional DBT-only-detected cancers.

Conclusions

DBT-supplemented screening resulted in significant increases in screen-detected cancers and specificity. However, no significant change was observed in the rate, size, node status, or grade of interval cancers.

ClinicalTrials.gov: NCT01248546.

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Acknowledgements

The study has used data from the Cancer Registry of Norway. The interpretation and reporting of the data are the sole responsibility of the authors, and no endorsement by the Cancer Registry of Norway is intended or should be inferred.

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Authors and Affiliations

  1. Division of Radiology and Nuclear Medicine, Breast Imaging Center, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0407, Oslo, Norway

    Per Skaane

  2. Department of Screening, Cancer Registry of Norway, Oslo, Norway

    Sofie Sebuødegård

  3. Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA

    Andriy I. Bandos

  4. Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA

    David Gur

  5. The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway

    Bjørn Helge Østerås

  6. Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway

    Randi Gullien

  7. Department of Screening, Cancer Registry of Norway, Oslo and Akershus University College of Applied Sciences, Oslo, Norway

    Solveig Hofvind

Authors
  1. Per Skaane
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  2. Sofie Sebuødegård
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  3. Andriy I. Bandos
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  4. David Gur
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  5. Bjørn Helge Østerås
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  6. Randi Gullien
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  7. Solveig Hofvind
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Corresponding author

Correspondence to Per Skaane.

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Conflicts of interest

Per Skaane received equipment and funding for additional case interpretations from Hologic, Inc. No conflict of interest for Sofie Sebuødegård, Andriy I. Bandos, David Gur, Bjørn Helge Østerås, Randi Gullien, and Solveig Hofvind.

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Skaane, P., Sebuødegård, S., Bandos, A.I. et al. Performance of breast cancer screening using digital breast tomosynthesis: results from the prospective population-based Oslo Tomosynthesis Screening Trial. Breast Cancer Res Treat 169, 489–496 (2018). https://doi.org/10.1007/s10549-018-4705-2

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  • DOI: https://doi.org/10.1007/s10549-018-4705-2

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