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Radiologists have been challenged by the ever-changing recommendations of when breast cancer screening should begin and the frequency of screening, says Sarah M.Friedewald, MD, division chief, Breast and Women’s Imaging, and medical director, Lynn Sage Comprehensive Breast Cancer Center, Northwestern Memorial Hospital.A snapshot of the evidence Several retrospective studies investigating tomosynthesis as a breast cancer screening tool have been conducted in the U. and all have demonstrated that DBT in combination with DM diminishes recall rates versus DM alone.
Another view: synthetic 2D mammography Despite its benefits, DBT added to DM for screening can more than double the radiation dose to the breast.
FDA-approved in 2013, synthetic 2D mammography mitigates this problem by generating simulated DM images from DBT scans, thereby avoiding the additional radiation exposure. Holt, retrospectively collected 32,076 DM, 30,561 DM-DBT, and 16,173 DBT-synthetic 2D screening mammograms from a large community-based cancer center, and analyzed the diagnostic performance of each modality.
As a multitude of published studies suggest, the addition of tomosynthesis to DM significantly lowers recall rates and improves cancer detection, says Jacqueline Holt, MD, Director of Breast Imaging at the Helen F.
Food and Drug Administration (FDA) in 2011, this imaging technology, also referred to as 3D mammography, has been increasingly integrated into clinical practice across the U. and around the world as an adjunct to standard 2-view digital screening mammography (DM).
This increase mainly included invasive cancers, not ductal carcinoma in situ, “which is important given current concerns for potential overdiagnosis and overtreatment,” wrote Steven Poplack, MD, in a 2017 review summarizing clinical DBT data.
“It has been fairly well established that, when used in the screening setting, tomosynthesis decreases recalls,” comments Carol Lee, MD, a diagnostic radiologist at Memorial Sloan Kettering Cancer Center in New York.
The number of images a tomosynthesis machine takes is based on the individual manufacturer recommendations, explained Friedewald, and not a radiologist’s decision.
“For example, if a breast has a 5% compression, the tomosynthesis scan might result in 54 images; but not to be confused, there’s not 54 images of the breast taken for us to look at.” Tomosynthesis received FDA approval in 2011.
The controversy surrounding screening recommendations can be a distraction to the implementation of new technologies, such as tomosynthesis, a screening process that renders 3D-like images of the breast.
It’s one of the biggest improvements to come along since digital imaging, and for good reason, Friedewald told an audience during a presentation at the 2016 Lynn Sage Breast Cancer Symposium.