How Beneficial Is 3D Mammography with Tomosynthesis?

Three-dimensional imaging increased sensitivity and lowered false-positive rates, but isn't currently appropriate for routine screening.

Three-dimensional (3D) mammography with tomosynthesis uses a moving x-ray source to construct a series of thin-section images of the breast. Although this imaging mode has been recommended for high-risk women and those with radiologically dense breast tissue, few studies have addressed its use in routine screening. In a manufacturer-funded prospective study in Italy, women aged 48 were invited to receive both 2D and 3D mammography (performed during a single compression of the breast) as part of their routine screening. Each radiologist interpreted images sequentially, first using standard 2D mammography, then (on the same day) using an integrated 2D/3D image. Radiologists determined whether to recall women for additional evaluation after reading the standard image and again after analyzing the integrated imaging.

Among 7292 participants (median age, 58), 52 invasive cancers and 7 cases of ductal carcinoma in situ were detected. Of these 59 malignancies, 39 were detected with both 2D and integrated 2D/3D imaging, 20 were detected only with integrated 2D/3D imaging, and none were detected with 2D imaging alone. Cancer detection rates per 1000 screens were 5.3 with 2D only and 8.1 with integrated screening (P<0.0001). Of 395 false-positive screens (5.5%), 181 resulted from both screens, 141 resulted only from 2D, and 73 only from integrated screens.

CITATION(S):

Ciatto S et al. Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): A prospective comparison study. Lancet Oncol 2013 Apr 25; [e-pub ahead of print].