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    Is 3D mammography the future of breast cancer screening?



    Adding tomosynthesis, or 3D mammography, to digital mammography may increase cancer detection and reduce false-positive results from screening, according to study in JAMA. The report reflects outcomes from a geographically diverse group of practices that included academic and nonacademic settings and specialist and nonspecialist radiologists.

    More than 450,000 examinations were included in a retrospective analysis by researchers at the University of Pennsylvania of screening performance metrics at 13 academic and nonacademic breast centers, which using mixed models and adjusted for site as a random effect. Exposures were to 3D mammography alone were during a 1-year period before implementation of the technology (Period 1; March 2010 to October 2011) and to digital and 3D mammography after the technology was implemented (Period 2; March 2011 to December 31, 2012).

    Over the course of the study, 281,187 digital mammography examinations and 173 663 examinations with digital mammography plus 3D mammography were assessed. Use of digital mammography alone resulted in recall of 29,376 patients and performance of 5056 biopsies, with cancer diagnoses in 1207 patients (n=815 invasive; n=392 in situ). Tomosynthesis plus digital mammography resulted in recall of 15,541 patients and performance of 3285 biopsies, withcancer diagnoses in 950 patients (n=707 invasive; n=243 in situ).

    With adjustment for model, the rate of recall per 1000 screens was 107 (95% confidence interval [CI]) with digital mammography versus 91 (95% CI, 73-108) when combined with 3D mammography (difference -16; 95% CI, -18 to -14, P<.001). The model-adjusted rate per 1000 cases of  for cancer detection with digital mammography was 4.2 (95% CI, 3.8-4.7), which increased to 5.4 (95% CI, 4.9-6.0), (difference, 1.2; 95% CI, 0.8-1.6; P < .001) with the addition of 3D mammography. Invasive cancers were detected in 4.1 out of 1000 cases (95% CI, 3.7-4.5) with digital mammography plus 3D mammography, versus 2.9 in the digital mammography-only group (95% CI, 2.5-3.2), a difference of  1.2 (95% CI, 0.8-1.6; P< .001). The rate of in situ cancer detection was the same in both groups: 1.4 (95% CI, 1.2-1.6) per 1000 screens.

    The investigators concluded that adding 3D mammography to digital mammography decreased the recall rate and increased detection of cancer, particularly of invasive forms. They urged further study to identify the relationship between use of the technology and clinical outcomes.




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    Miranda Hester
    Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.
    Judith M. Orvos, ELS
    Judith M. Orvos, ELS, is an editorial consultant for Contemporary OB/GYN.


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