- 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 show 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%
- Found an increase in detection rate of invasive breast cancer:
- Skaane et al:
- Found a 40% increase in the detection of invasive cancers with a 15% reduction in false negatives
- Rose et al.3 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
- Ciatto et al:
- 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 3,231 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
- Ciatto S, Houssami N, Bernardi D, Caumo F, Pellegrino M, Brunelli S, et al. Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study. Lancet Oncol. 2013;14(7):583-589.
- Skaane P, Bandos AI, Gullien R, Eben EB, Ekseth U, Haakenaasen U, et al. Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology. 2013;267(1):47-56.
- 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(3):694-700.
- 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(6):1401-1408.
- Friedewald SM, Rafferty EA, Rose SL, Durand MA, Plecha DM, Greenberg JS, et al. Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA. 2014;311(24):2499-2507.
- Tagliafico AS, Calabrese M, Mariscotti G, Durando M, Tosto S, Monetti F, 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;34(16):1882-1888.
Rodrigo Arrangoiz MS, MD, FACS, FSSO 