BACKGROUND AND PURPOSE:

• Ho et al. (JAMA Network Open, 2022) compared false positive results with digital breast tomosynthesis (3-dimensional mammography) vs digital mammography

METHODS:

• Prospective observational comparative effectiveness study
  • 126 breast imaging facilities participating in 6 US registries
• Population
  • 40 to 79 years
  • Screening examinations performed between January 2005 and December 2018
• Exposures
  • Digital breast tomosynthesis
  • Digital mammography
• Study design
  • Following exam characteristics were also noted
    • Screening interval
    • Age
    • BIRADS breast density
• Primary outcomes
  • After 10 years of annual or biennial screening, cumulative risk of ≥1 false positive leading to
    • Recall for further imaging
    • Short-interval follow-up recommendation
    • Biopsy recommendation

RESULTS:

• 903,495 women | 2,969,055 nonbaseline screening examinations | 699 radiologists
  • Mean age at screening was 57.6 years
  • <60 years: 58%
  • Dense breasts: 46%
  • Use of tomosynthesis: 15%

Annual Screening

• Cumulative probability of at least 1 false positive result was significantly lower with tomosynthesis vs digital mammography
  • Recall for further imaging
    • Tomosynthesis: 49.6%
    • Mammography: 56.3%
    • Difference –6.7 (95% CI, –7.4 to –6.1)
  • Short interval follow-up recommendation
    • Tomosynthesis: 16.6%
    • Mammography: 17.8%
    • Difference –1.1 (95% CI, –1.7 to –0.6)
  • Biopsy recommendation
    • Tomosynthesis: 11.2%
    • Mammography: 11.7%
    • Difference –0.5 (95% CI, –1.0 to –0.1)

Biennial Screening

• Cumulative probability of a false-positive recall was significantly lower for tomosynthesis vs digital mammography
  • Tomosynthesis: 35.7%
  • Mammography: 38.1%
  • Difference –2.4 (95% CI, –3.4 to –1.5)
• No difference for
  • Short-interval follow-up recommendation
  • Biopsy recommendation

Breast Density

• Decreases in cumulative probabilities of false-positive results with tomosynthesis vs digital mammography and were largest for annual screening in women with nondense breasts

Other Factors Associated with Lower False Positive Results

• Biennial vs annual screening (overall)
• Older vs younger age groups (70 to 79 years vs 40 to 49 years)
• Entirely fatty vs extremely dense breasts

CONCLUSION:

• The 10-year cumulative probabilities of false positive breast cancer screening exams were reduced with use of digital breast tomosynthesis vs digital mammography
• Regardless of screening modality, the following were associated with larger reductions in false positive probabilities
  • Biennial screening interval
  • Older age
  • Nondense breasts
• The authors state

In this comparative effectiveness study, 10-year cumulative probabilities of false-positive results were lower on digital breast tomosynthesis vs digital mammography

Biennial screening interval, older age, and nondense breasts were associated with larger reductions in false-positive probabilities than screening modality

Learn More – Primary Sources:

Cumulative Probability of False-Positive Results After 10 Years of Screening With Digital Breast Tomosynthesis vs Digital Mammography

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