Impact on the recall rate of digital breast tomosynthesis as an adjunct to digital mammography in the screening setting. A double reading experience and review of the literature

• Published in: European journal of radiology 2016-04, Vol.85 (4), p.808-814
• Main Authors: Carbonaro, Luca A, Di Leo, Giovanni, Clauser, Paola, Trimboli, Rubina M, Verardi, Nicola, Fedeli, Maria P, Girometti, Rossano, Tafà, Alfredo, Bruscoli, Paola, Saguatti, Gianni, Bazzocchi, Massimo, Sardanelli, Francesco
• Format: Article
• Language: English
• Subjects: Aged; Biopsy, Needle - methods; Breast - pathology; Breast cancer; Breast Cyst - diagnostic imaging; Breast Cyst - pathology; Breast Density; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - pathology; Carcinoma, Ductal, Breast - diagnostic imaging; Carcinoma, Ductal, Breast - pathology; Digital breast tomosynthesis (DBT); Digital mammography (DM); Female; Fibroadenoma - diagnostic imaging; Fibroadenoma - pathology; Follow-Up Studies; Humans; Image-Guided Biopsy - methods; Mammography - statistics & numerical data; Mass Screening - statistics & numerical data; Middle Aged; Multimodal Imaging - statistics & numerical data; Observer Variation; population based; Population Surveillance; Predictive Value of Tests; Prospective Studies; Radiographic Image Enhancement - methods; Radiology; Recall rate; Screening; Sensitivity and Specificity; Tomography, X-Ray - statistics & numerical data
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2016.01.004

Abstract Objectives To estimate the impact on recall rate (RR) of digital breast tomosynthesis (DBT) associated with digital mammography (DM + DBT), compared to DM alone, evaluate the impact of double reading (DR) and review the literature. Methods Ethics committees approved this multicenter study. Patients gave informed consent. Women recalled from population-based screening reading were included. Reference standard was histology and/or ≥1 year follow up. Negative multiple assessment was considered for patients lost at follow up. Two blinded readers (R1, R2) evaluated first DM and subsequently DM + DBT. RR, sensitivity, specificity, accuracy, positive and negative predictive values (PPV, NPV), were calculated for R1, R2, and DR. Cohen κ and χ2 were used for R1-R2 agreement and RR related to breast density. Results We included 280 cases (41 malignancies, 66 benign lesions, and 173 negative examinations). The RR reduction was 43% (R1), 58% (R2), 43% (DR). Sensitivity, specificity, accuracy, PPV and NPV were: 93%, 67%, 71%, 33%, 98% for R1; 88%, 73%, 75%, 36%, 97% for R2; 98%, 55%, 61%, 27%, 99% for DR. The agreement was higher for DM + DBT ( κ =0.459 versus κ =0.234). Reduction in RR was independent from breast density ( p = 0.992). Conclusion DBT was confirmed to reduce RR, as shown by 13 of 15 previous studies (reported reduction 6–82%, median 31%). This reduction is confirmed when using DR. DBT allows an increased inter-reader agreement.