Diagnostic Tests

What Physicians Need to Know

Digital Breast Tomosynthesis for Breast Cancer Screening

 

Am Fam Physician. 2021 Apr 1;103(7):430-431.

Digital breast tomosynthesis (DBT), or 3D mammography, is a breast imaging technique in which multiple radiographs are used to reconstruct a 3D picture. Approved by the U.S. Food and Drug Administration in 2011, DBT is purported to be more sensitive and specific than digital mammography, especially in women with dense breasts.1 Although DBT has not been universally accepted as the standard for breast cancer screening, it has supplanted digital mammography for screening in some parts of the United States; areas with higher DBT use tend to be wealthier and have larger White populations.2

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TestIndicationPopulationCost*

Digital breast tomosynthesis

Screening for breast cancer

Women 40 years or older

$208


*—The fair price represents reasonable out-of-pocket costs based on price comparisons. Actual cost will vary with insurance and by region. Information obtained at https://healthcarebluebook.com (accessed February 16, 2021; zip code: 66211).

TestIndicationPopulationCost*

Digital breast tomosynthesis

Screening for breast cancer

Women 40 years or older

$208


*—The fair price represents reasonable out-of-pocket costs based on price comparisons. Actual cost will vary with insurance and by region. Information obtained at https://healthcarebluebook.com (accessed February 16, 2021; zip code: 66211).

Accuracy

In experimental studies of mastectomy specimens, DBT was superior to digital mammography in lesion detection and margin identification.3 It is not clear how this difference translates to real-life screening. The ongoing Tomosynthesis Mammographic Imaging Screening Trial compares the effectiveness of DBT and digital mammography in preventing advanced breast cancers through screening of average-risk women in the United States.4 Trial recruitment has been challenging as more hospitals adopt the newer technology. Hospitals and patients are reluctant to accept digital mammography despite the lack of evidence that DBT is superior.5 Retrospective studies suggest that when used in conjunction with digital mammography, DBT decreases recall rate and improves cancer detection in women.6

A systematic review found low-quality evidence that DBT plus digital mammography increases the overall and invasive breast cancer detection rates.7 Digital mammography alone detected 7 breast cancers per 1,000 screenings and 5 invasive breast cancers per 1,000 screenings. With the addition of DBT, detection rates increased to 10 per 1,000 screenings and 7 per 1,000 screenings, respectively. However, the review found no moderate- or high-quality evidence that DBT decreases recall

Address correspondence to Kathleen Barry, MD, at kathleen.barry@umassmemorial.org. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

1. Bian T, Lin Q, Cui C, et al. Digital breast tomosynthesis: a new diagnostic method for mass-like lesions in dense breasts. Breast J. 2016;22(5):535–540....

2. Richman IB, Hoag JR, Xu X, et al. Adoption of digital breast tomosynthesis in clinical practice. JAMA Intern Med. 2019;179(9):1292–1295.

3. Seo N, Kim HH, Shin HJ, et al. Digital breast tomosynthesis versus full-field digital mammography: comparison of the accuracy of lesion measurement and characterization using specimens. Acta Radiol. 2014;55:661–667.

4. National Cancer Institute. TMIST (Tomosynthesis Mammographic Imaging Screening Trial). Accessed February 20, 2021. https://www.cancer.gov/about-cancer/treatment/clinical-trials/nci-supported/tmist

5. Mulcahy N. Hard times for America's $100M breast cancer screening trial. Medscape. February 13, 2020. Accessed February 20, 2021. https://www.medscape.com/viewarticle/925193

6. Hofvind S, Holen AS, Aase HS, et al. Two-view digital breast tomosynthesis versus digital mammography in a population-based breast cancer screening programme (To-Be): a randomised, controlled trial [published correction appears in Lancet Oncol. 2019;20(7):e346]. Lancet Oncol. 2019;20(6):795–805.

7. Giampietro RR, Cabral MVG, Lima SAM, et al. Accuracy and effectiveness of mammography versus mammography and tomosynthesis for population-based breast cancer screening: a systematic review and meta-analysis. Sci Rep. 2020;10(1):7991.

8. Alabousi M, Zha N, Salameh JP, et al. Digital breast tomosynthesis for breast cancer detection: a diagnostic test accuracy systematic review and meta-analysis. Eur Radiol. 2020;30(4):2058–2071.

9. Thompson W, Argaez C. Digital breast tomosynthesis for the screening and diagnosis of breast cancer: a review of the diagnostic accuracy, cost-effectiveness and guidelines. Canadian Agency for Drugs and Technologies in Health. October 28, 2019. Accessed February 20, 2021. https://cadth.ca/digital-breast-tomosynthesis-screening-and-diagnosis-breast-cancer-review-diagnostic-accuracy-cost-0

10. U.S. Preventive Services Task Force. Final recommendation statement. Breast cancer: screening. January 11, 2016. Accessed February 20, 2021. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening

11. American College of Radiology. ACR Appropriateness Criteria. Breast cancer screening. Accessed February 20, 2021. https://acsearch.acr.org/docs/70910/Narrative/

12. Healthcare Bluebook. Accessed February 16, 2021 (zip code: 66211). https://www.healthcarebluebook.com

13. Kalra VB, Wu X, Haas BM, et al. Cost-effectiveness of tomosynthesis in annual screening mammography. AJR Am J Roentgenol. 2016;207(5):1152–1155.

14. Marinovich ML, Hunter KE, Macaskill P, et al. Breast cancer screening using tomosynthesis or mammography: a meta-analysis of cancer detection and recall. J Natl Cancer Inst. 2018;110(9):942–949.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

A collection of Diagnostic Tests published in AFP is available at https://www.aafp.org/afp/diagnostic.

 

 

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