Sensitivity of Digital Mammography Plus Tomosynthesis in Breast Cancer Screening
Posted: Friday, August 31, 2018
Digital mammography plus digital breast tomosynthesis detected 89% more cancers than digital mammography alone, according to a recent randomized controlled trial in Italy. This preliminary analysis from the Reggio Emilia Tomosynthesis trial was published in Radiology by Pierpaolo Pattacini, MD, of AUSL Reggio Emilia, Italy, and colleagues.
“Tomosynthesis and digital mammography is much more sensitive than digital mammography,” Dr. Pattacini said in a press release from the Radiological Society of North America. “If these small cancers never became life-threatening, then we are increasing overdiagnosis and not impacting mortality,” said coauthor Paolo Giorgi Rossi, PhD. “Thus, we need to have a measure of the impact of this higher detection rate on the incidence of advanced cancers and interval cancers in the following years.”
At the time of the analysis, the two-arm, test-and-treat, randomized controlled trial had enrolled 9,777 women for the experimental arm of the study with mammography plus tomosynthesis and 9,783 women for the control arm with mammography alone. The median age of each arm was 56 years, and the range was between age 45 and 70. Women had previously participated in at least one round of digital mammography screening in the same program.
Digital mammography plus tomosynthesis detected 8.6 cancers per 1,000 patients, 89% greater than detection in the control arm of the trial, which was 4.5 cancers per 1,000 patients. The increase in detection was higher for ductal carcinoma in situ (180%) than for invasive cancers. The greater detection was 94% for invasive cancers less than 10 mm, and 122% for those between 10 mm and 19 mm, but there was no gain in detection for invasive cancers greater than 20 mm. Both arms of the study had a recall rate of 3.5%, and the positive predictive value of the recall was 13.0% in the control arm and 24.1% in the experimental arm.