Breast cancer screening: Does tomosynthesis augment mammography?

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FIGURE 1
Schematic representation of image acquisition with breast tomosynthesis.
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FIGURE 2
Example of masking by overlapping layers of breast tissue in a 2-dimensional (2D) digital mammogram, which can be mitigated by digital breast tomosynthesis (DBT). A, the 2D mediolateral oblique view of the left breast is normal in appearance. B, the corresponding 3D DBT slice demonstrates a large area of architectural distortion (circled area with spiculated appearance) in the superior left breast that represents invasive ductal carcinoma.
Images courtesy of Diana L. Lam, MD, University of Washington, Seattle.

TABLE 1

Tomosynthesis for breast cancer screening: Methodology and findings from 3 large cohort studies

Author, year	Study design and location	No. of participants or examinations	Cancer detection rates (per 1,000)^a	Recall rates (%)^a	Positive predictive values (%)^a
Houssami et al⁸ 2014 (STORM trial)	Prospective population-based cohort in Italy Single and double reading^b	7,292^c	7.5 vs 4.8	3.6 vs 4.2	21 vs 11.4
Skaane et al⁵ 2013 (Oslo trial)	Prospective cohort in Norway (interim analysis) Double reading	12,631	8.0 vs 6.1	6.1 vs 6.7	28.5 vs 29.1
Friedewald et al¹¹ 2014	Retrospective cohort in multiple US states Single reading	454,850^d	5.4 vs 4.2	9.1 vs 10.7	6.4 vs 4.3

↵a Combined digital breast tomosynthesis (DBT) plus digital mammography (DM) vs digital mammography alone.
↵b Table includes single-reading results only.
↵c 5% of invited women declined DBT plus DM.
↵d 173,663 examinations with DBP plus DM, 281,187 with DM only.
STORM = Screening With Tomosynthesis or Standard Mammography