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Digital breast tomosynthesis (DBT) screening shows improved accuracy over digital mammography (DM), detecting more invasive cancers with fewer advanced markers. This advancement in breast cancer screening offers better diagnostic performance and potentially improved patient outcomes.

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Area of Science:

  • Radiology and Imaging
  • Oncology
  • Medical Diagnostics

Background:

  • Digital breast tomosynthesis (DBT) enhances breast cancer detection and recall rates compared to digital mammography (DM).
  • The impact of DBT on patient survival remains unestablished, necessitating surrogate markers like false-negative (FN) rates.
  • FN screening examinations can indicate long-term breast cancer morbidity and mortality outcomes.

Purpose of the Study:

  • To evaluate if DBT screening is associated with lower FN rates compared to DM.
  • To determine if DBT detects cancers with more favorable prognoses than DM.
  • To assess if DBT improves overall performance outcomes in breast cancer screening.

Main Methods:

  • A retrospective study analyzed 380,641 screening examinations from 10 academic and community practices.
  • Data included digital mammography (DM) examinations prior to DBT implementation and subsequent DBT examinations.
  • Cancers after FN examinations were characterized, and rates of FN, sensitivity, specificity, and tumor characteristics were compared between DBT and DM.

Main Results:

  • DBT showed improved sensitivity (89.8%) and specificity (90.7%) compared to DM (85.6% and 89.1%, respectively).
  • While overall and symptomatic FN rates trended lower with DBT, asymptomatic FN rates were higher in women with dense breasts.
  • Cancers detected with DBT were more frequently invasive, with fewer positive lymph nodes and distant metastases, and lower odds of being advanced.

Conclusions:

  • Screening with digital breast tomosynthesis (DBT) significantly improves sensitivity and specificity in breast cancer detection.
  • DBT identifies more invasive cancers with less advanced nodal or distant metastasis compared to digital mammography (DM).
  • These findings suggest DBT offers superior performance in breast cancer screening, potentially leading to better patient outcomes.