Benefits from the addition of tomosynthesis to conventional digital mammography alone

Rodrigo Arrangoiz MS, MD, FACS, FSSO
👉Debate on adjunct screening in women with dense breasts has resulted from legislation mandating that women be informed if their mammograms show dense breast tissue, including informing them that other screening modalities are available.
👉In addition to MRI and molecular imaging, both tomosynthesis and breast ultrasound are additional techniques for enhanced screening in patients with dense breasts.

👉Multiple studies have now shown significant benefits from the addition of tomosynthesis to conventional digital mammography alone in screening programs.

👉Ciatto et al. found an increase in detection rate of invasive breast cancer from 5.3/1000 to 8.1/1000, while also decreasing the recall rate by 17%.
👉Skaane et al. found a 40% increase in the detection of invasive cancers with a 15% reduction in false negatives.
👉Rose et al. and Haas et al. showed statistically significant relative reductions in recall rates of 37% and 30%, respectively.
👉A recent retrospective review of 454,850 examinations in 13 screening centers in the United States demonstrated a 41% increase in invasive cancer detection, a 15% reduction in call backs, and a 49% increase in the positive predictive value for recall.
👉Implementation of tomosynthesis did not lead to a significant reduction in biopsy rates as compared to digital mammography screening.
👉As yet, there are no data that show a reduction in mortality with enhanced screening in dense breasts.

👉A prospective multicenter study compared tomosynthesis with bilateral physician hand-held ultrasound screening in 3231 asymptomatic patients with mammography-negative dense breasts. 

– In all, 24 additional cancers were detected, 23 of which were invasive.
– Tomosynthesis detected 13 cancers, and ultrasound detected 23.
– These data suggest that even though tomosysthesis significantly increases the number of cancers found in dense breasts, in the hands of a skilled breast radiologist, ultrasound may be even better. 

👉REFERENCES

  1. Ciatto S, Houssami N, Bernardi D, et al. Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study. Lancet Oncol. 2013;14:583-589.
  2. Friedewald SM, Rafferty EA, Rose SL, et al. Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA. 2014;311:2499-2507.
  3. Haas BM, Kalra V, Geisel J, Raghu M, Durand M, Philpotts LE. Comparison of tomosynthesis plus digital mammography and digital mammography alone for breast cancer screening. Radiology. 2013;269:694-700.
  4. Rose SL, Tidwell AL, Bujnoch LJ, Kushwaha AC, Nordmann AS, Sexton R Jr. Implementation of breast tomosynthesis in a routine screening practice: an observational study. AJR Am J Roentgenol. 2013;200:1401-1408.
  5. Skaane P, Bandos AI, Gullien R, et al. Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology. 2013;267:47-56.
  6. Tagliafico AS, Calabrese M, Mariscotti G, et al. Adjunct screening with tomosynthesis or ultrasound in women with mammography-negative dense breasts: interim report of a prospective comparative trial. J Clin Oncol. 2016 Mar 9. pii: JCO634147. [Epub ahead of print]

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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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