Prospective study aiming to compare 2D mammography and tomosynthesis + synthesized mammography in terms of cancer detection and recall. From double reading of 2D mammography to single reading of tomosynthesis

Eur Radiol. 2018 Jun;28(6):2484-2491. doi: 10.1007/s00330-017-5219-8. Epub 2018 Jan 2.


Objectives: To evaluate tomosynthesis compared with 2D-mammography in cancer detection and recalls in a screening-programme, and assess performing synthesized instead of 2D, and compare double reading of 2D with single reading of tomosynthesis.

Methods: Women (age 50-69 years) participating in the screening-programme were included. 2D-mammography and tomosynthesis were performed. There were four reading models: 2D-mammography (first); 2D-mammography (second); tomosynthesis + synthesized (third); tomosynthesis + synthesized + 2D (fourth reading). Paired double reading of 2D (first+second) and tomosynthesis (third+fourth) were analysed.

Results: In 16,067 participants, there were 98 cancers and 1,196 recalls. Comparing double reading of 2D with single reading of tomosynthesis, there was an increase of 12.6 % in cancer detection with the third reading (p= 0.043) and 6.9 % with the fourth reading (p=0.210), and a decrease in recalls of 40.5 % (p<0.001) and 44.4 % (p<0.001), respectively. With double reading of both techniques, there was an increase in cancer detection of 17.4 % (p = 0.004) and a decrease in recalls of 12.5 % (p = 0.001) with tomosynthesis.

Conclusion: Single reading of tomosynthesis plus synthesized increased cancer detection and decreased recalls compared with double reading 2D. 2D did not improve results when added to tomosynthesis.

Key points: • Tomosynthesis increases cancer detection and decreases recall rates versus 2D mammography. • Synthesized-mammography avoids performing 2D, showing higher cancer detection. • Single reading of tomosynthesis + synthesized is feasible as a new practice.

Keywords: Breast cancer; Digital breast tomosynthesis; Mammography; Radiology; Screening.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Breast Neoplasms / diagnostic imaging*
  • Breast Neoplasms / pathology
  • Early Detection of Cancer / methods
  • Female
  • Humans
  • Imaging, Three-Dimensional / methods
  • Mammography / methods*
  • Mass Screening / methods
  • Middle Aged
  • Neoplasm Grading
  • Predictive Value of Tests
  • Prospective Studies
  • Radiographic Image Interpretation, Computer-Assisted / methods*