Will breast tomosynthesis completely replace 2-D mammo?

Will breast tomosynthesis completely replace 2-D mammo?

by Christina Hwang, Contributing Reporter | July 04, 2016
Mammomat Inspiration
from Siemens Healthineers
From the July 2016 issue of HealthCare Business News magazine

Before breast tomosynthesis, or 3-D mammography, there was digital 2-D mammography, before digital 2-D, there was film. Though tomosynthesis is still being tested in clinical studies, radiologists across the country are optimistic about this new technology and what it could mean for the future of breast cancer screening.

Shoshannah Roth, manager of health technology assessment information services at ECRI Institute in Plymouth Meeting, Pennsylvania, draws an analogy between the breast and a book, and how 2-D mammography takes the breast information and puts it all on one page, which can be difficult for some radiologists to read. Tomosynthesis, on the other hand, allows radiologists to look at the breast in slices, or multiple pages.

“Radiologists can look at a couple of pages at a time and flip through the book,” says Roth. “This allows them to see certain features easier because they’re no longer covered up or obscured by surrounding tissue.” In 2014, a study involving 139 doctors from 13 U.S. academic and community-based hospitals and led by Dr. Sarah M. Friedewald of the Caldwall Breast Center at Advocate Lutheran General Hospital in Illinois, looked at 281,187 conventional mammograms and compared them to 173,663 tomosynthesis exams.

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The findings, published in the Journal of the American Medical Association (JAMA), illustrated that tomosynthesis detected 41 percent more invasive breast cancers (and 29 percent more breast cancers overall) than 2-D mammography. Additionally, the study showed a 15 percent decrease in women recalled for additional screening, a 49 percent increase in positive predictive value for a recall and a 21 percent increase in positive predictive value for biopsy.

A follow-up study was conducted earlier this year, in which 278,906 conventional mammograms were compared to 173,414 tomosynthesis exams. That study, also published in JAMA, found a 50 percent increase in invasive cancer detection and a 14 percent reduction in recall rate.

“Our study answered the critical question of who should be imaged with tomosynthesis, providing compelling evidence that all women undergoing mammographic screening should be imaged with tomosynthesis, regardless of their breast density,” Dr. Elizabeth Rafferty, the lead investigator of the study, told HealthCare Business News, at that time.

A European study led by Dr. Per Skaane, Ph.D., from the department of radiology at Oslo University Hospital in Norway, compared full-field digital mammography (FFDM) to FFDM combined with tomosynthesis in 25,547 women between the ages of 50 and 69. Those results showed a 30 percent overall relative increase in cancer detection when combining the exams.

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