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Digital Breast Tomosynthesis
Digital breast tomosynthesis (3D mammography) significantly improves breast cancer detection rates and reduces false positive recalls compared to traditional 2D mammography. While it has limitations such as longer reading times and increased storage requirements, its enhanced sensitivity, especially for dense breasts, makes it a valuable tool in breast cancer screening. Legislative changes now require mammography facilities to report breast density, reflecting its impact on cancer detection and patient awareness.
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Digital Breast Tomosynthesis
- 1. Digital Breast Tomosynthesis 3DMammography Trudi Parker M.D.
- 2. Breast Cancer Statistics ACSEstimates for 2014 Most common cancer among American women 232,670 new cases of breast cancer diagnosed in women 2nd. Leading cause of cancer death in women, exceeded only by lung cancer 40,000 women will die from breast cancer
- 3. 5-Year Relative Survivalby Stage at Diagnosis www.seer.cancer.gov SEER 18 2004-2010, All Races, Females by SEER Summary Stage 2000
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- 6. Limitations of 2DMammography 20% of cancers will be missed Sensitivity decreases significantly with increased breast density Approximately 10% will be recalled for additional work up 75-80% of all breast biopsies will result in benign results
- 7. 2D versus 3DMammography Enhanced lesion detection – borders of lesion better defined Increased cancer detection rate Reduces false positive recalls Precise lesion localization
- 8. Technique: 2Dand 3D images obtained with one compression X-ray tube sweeps through a 15deg arc acquiring 15 low dose projections (~4secs) Mathematical reconstruction generates 1mm slices through the breast Radiation dose: ~2X the dose of a mammogram Still very low, below MQSA requirements C-view (synthesized 2D) 2D will no longer be needed Dose reduction Hologic
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- 10. Limitations of DBT Takes longer to read Cannot be read on demand or STAT Increased radiation Radiation dose: ~2X the dose of a mammogram Still very low, below MQSA requirements No CPT code Massive storage requirements
- 11. IT Storage Requirementsfor 20,000 Mammograms 2D Storage for standard 4 View Mammogram = 1.74 Terabytes/year 3D Storage for standard 4 View Mammogram = 10 Terabytes/year
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- 18. Oslo Norway DBT ScreeningTrial Prospective Trial : November 22,2010 to December 31,2011 4 Arms: 2D, 2D +CAD, 2D+3D, synthesized 2D+3D 12,621 sequentially recruited women Exams interpreted with mammography alone and compared with mammography + DBT
- 19. Oslo Norway DBT ScreeningTrial Results: Cancer Detection Rate of Invasive Cancer +DCIS 27% increase (p=.001) 40% Increase detection of invasive cancers Increase observed across all breast densities 2D Mammography alone: 6.1 cancers/1000 exams 2D + Tomosynthesis : 8 cancers/1000 exams
- 20. Oslo Norway DBT ScreeningTrial Results: False Positives ( Recalls from screening exams) Mammography alone : 61.1/1000 exams Mammography + Tomosynthesis : 53.1/1000 15% Decrease
- 21. JAMA Retrospective Trial :March 2010 – December 2012 454,850 examinations 13 sites (academic and nonacademic) Compared mammography interpretation performance 1 year prior to tomosynthesis implementation to performance following tomosynthesis implementation
- 22. JAMA Results: 454,850 examinations 281,187 2Dexams 173,663 2D+3D exams Recall Rate: 15% Cancer Detection Rate: 41% (invasive cancers) DCIS detection rate : no change
- 23. JAMA Results: PPV for recall: 49% PPV for biopsy : 21%
- 24. 56 year old, screening exam
- 27. The Breast DensityLegislation Effective August 1, 2014, a new law by the Minnesota State Legislature requires all Minnesota mammography facilities to report breast density to patients with dense breasts. This law was enacted for three reasons: 1. Dense breasts slightly decrease the ability of mammography to find breast cancer. 2. Dense breasts slightly increase the risk of breast cancer. 3. Patients may want to know about supplemental screening tests.
- 28. Supplemental Screening Options Breast MRI Expensive Requires IV contrast Recommended for select hi risk population (>20% lifetime risk of breast cancer) Screening US Slightly increased cancer detection but has high false positives Operator dependent, time consuming Digital Breast Tomosynthesis Only mammography has been shown to decrease mortality rates.
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- 30. Summary Digital BreastTomosynthesis Build on the success of the the screening mammogram Increased Sensitivity AND Specificity Right sizing breast imaging Replace 2D MammographyAllina website
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