Impact of the Addition of Digital Breast Tomosynthesis (DBT) to Standard 2D Digital Screening Mammography on the Rates of Patient Recall, Cancer Detection, and Recommendations for Short-term Follow-up

Acad Radiol. 2017 Mar;24(3):302-307. doi: 10.1016/j.acra.2016.10.001. Epub 2016 Dec 2.


Rationale and objectives: The addition of digital breast tomosynthesis (DBT) to digital screening mammography (DM) has been shown to decrease recall rates and improve cancer detection rates, but there is a lack of data regarding the impact of DBT on rates of short-term follow-up. We assessed possible changes in performance measures with the introduction of DBT at our facility.

Materials and methods: In our observational study, databases were used to compare rates of recall, short-term follow-up, biopsy, and cancer detection between women undergoing DM without (n = 10,477) and women undergoing DM with (n = 2304) the addition of DBT. Regression analysis was performed to determine associations with patient age, breast density, and availability of comparison examinations.

Results: The addition of DBT resulted in significantly lower recall rates (16%-14%, P = .017), higher rates of biopsy (12.7%-19.1%, P < .01), and increased detection of ductal carcinoma in situ, with a difference of 2.3 cases per 1000 screens (P = .044). A 33% increase in cancer detection rates was observed with DBT, which did not reach statistical significance. Short-term follow-up of probably benign findings was 80% higher in the DBT group (odds ratio = 1.80, 95% confidence interval = 1.38-2.36, P < .001).

Conclusions: To our knowledge, we are the first to study the impact of DBT on rates of short-term follow-up, and observed an 80% increase over the DM group. Further research is needed to determine the malignancy rate of Breast Imaging Reporting and Data System 3 lesions detected with DBT, and establish appropriate follow-up to maximize cancer detection while minimizing expense and patient anxiety.

Keywords: BIRADS 3; DBT; DCIS; short-term follow-up; tomosynthesis.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Biopsy
  • Breast / diagnostic imaging
  • Breast / pathology
  • Breast Neoplasms / diagnostic imaging*
  • Breast Neoplasms / pathology
  • Early Detection of Cancer / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Image Processing, Computer-Assisted / methods
  • Mammography / methods*
  • Middle Aged
  • Radiographic Image Interpretation, Computer-Assisted / methods*
  • Reproducibility of Results
  • Retrospective Studies