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3-D Imaging Boosts Breast Cancer Detection

Addition of 3D mammography to conventional mammography increased cancer detection rates and decreased false positive rates.

By Charles Bankhead, MedPage Today

Medically Reviewed by F. Perry Wilson, MD, MSCE

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FRIDAY, Jan. 11, 2013 (MedPage Today) —Breast cancer detection increased by 27 percent when three-dimensional mammography was combined with conventional breast imaging, investigators reported.

The combined detection rate for invasive and in situ cancers was 6.1 per 1,000 exams with conventional mammography and 8.0 per 1,000 with combined imaging.

Combining 3D mammography (tomosynthesis) with conventional imaging led to a 40 percent increase in detection of invasive breast cancers and a 15 percent decrease in false-positive results, according to an article published online inRadiology.

"The overall actual number of women recalled as a result of arbitration was larger for those initially assigned a positive score at mammography plus tomosynthesis," Per Skaane, MD, PhD, of the University of Oslo in Norway, and co-authors wrote of their findings.

"However, the concordant increase in the detection of 24 additional cancers resulted in a similar positive predictive value for the cases ultimately recalled for arbitration.

"Because of the paired nature of the current study, these results could be biased against mammography plus tomosynthesis in that some of the dismissed cases initially referred on the basis of mammography alone might not have been dismissed if tomosynthesis had not been available at arbitration."

Despite its proven ability to reduce breast cancer mortality, screening mammography has several limitations, such as overlapping imaged tissue. As a result, several x-ray and non-x-ray imaging modalities have been evaluated adjuncts or replacements for conventional plain-film mammography.

Alternative imaging techniques evaluated to date have in common one potential drawback: Each is performed as a separate procedure that requires technical and professional resources.

Use of tomosynthesis has been limited by inadequacy of image reconstruction possible with two-dimensional data sets, the authors noted in their introduction. The advent of a new generation of detectors has created the potential to integrate tomosynthesis into routine clinical practice.

The feasibility of using tomosynthesis in breast imaging was demonstrated more than a decade ago, and the FDA recently approved the first commercial system for clinical use.

Clinical evaluation of tomosynthesis has consisted largely of small retrospective studies involving specific patient populations in experimental settings. Skaane and colleagues performed a randomized clinical trial to evaluate tomosynthesis in clinical practice.

The study was designed to address four issues: cancer detection rate with tomosynthesis; false-positive rate; positive predictive value for women recalled after arbitration of imaging results; and the types of cancers detected by tomosynthesis.

The researchers studied a subgroup of women enrolled in an ongoing breast cancer screening program in Norway. Investigators screened 12,631 women with both 2D mammography and tomosynthesis.

Screening consisted of two views of each breast by digital mammography and tomosynthesis, which added about 10 seconds to image acquisition for each view. Combined imaging doubled the radiation dose compared with mammography alone but remained within accepted safety limits.

Each image was interpreted independently by four experienced radiologists, and a positive score was ≥2. All positive scores were reviewed during an arbitration meeting to reach a consensus.

The final analysis included 12,621 study participants. Mammography alone resulted in the detection of 77 cancers, and mammography plus tomosynthesis increased the detections to 101, a difference that translated into a 31 percent increase in the detection rate with combined imaging.

Adjustment for reader-specific performance levels resulted in a ratio of 1.27 for combined imaging versus mammography alone.

Evaluation of the different types of cancer detected by the two imaging strategies showed that mammography plus tomosynthesis led to detection of 81 invasive cancers versus 56 with mammography alone, a 40 percent improvement. Use of tomosynthesis also increased detection of higher-grade cancers by 26 percent.

Arbitration led to recall of 265 women (77 with cancer) and 351 with combined imaging (100 with cancer), resulting in positive predictive values of 29.1 percent and 28.5 percent, respectively.

"These results suggest that, despite the fact that the number of cases assigned a positive score before arbitration and recalled after arbitration was greater with mammography plus tomosynthesis, there was no substantial decrease in the positive predictive value in these patients," the authors noted.

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