Breast tomosynthesis after screening mammography reduces need for ultrasound and biopsies

Breast tomosynthesis in the diagnostic workup for one- or two-view focal asymmetry detected at screening mammography resulted in less use of ultrasound, fewer biopsies, and higher positive predictive value for cancer than when diagnostic examinations involved only two-dimensional mammography, according to a new study. This research was presented at the 2014 American Roentgen Ray Society, in San Diego, California.

“Tomosynthesis has been evaluated in screening populations and been shown to decrease recall rates,” said researcher Brandi Nicholson, MD, of the University of Virginia in Charlottesville, “but studies in the diagnostic setting are lacking.”

A total of 532 patients who were recalled for a focal asymmetric density discovered at screening were analyzed across three categories. The categories were women recalled prior to the availability of tomosynthesis in the practice (PT), those who did not have tomosynthesis at diagnostic evaluation after it was available (NT), and those who had diagnostic tomosynthesis (YT).

The study had 238 patients in the PT group, 145 in the NT group, and 149 in the YT group. The three groups were similar in age of the patients. The YT and NT groups had similar focal asymmetric density that was seen on one or two views.

The researchers found that additional full views, such as exaggerated craniocaudal or mediolateral oblique, and ultrasound were performed significantly less frequently in the group that had diagnostic tomosynthesis (YT group) than in both the groups that did not have tomosynthesis (the PT and NT groups). Both groups that did not have tomosynthesis (the PT and NT groups) had similar use of ultrasound.

They also found that the positive predictive value was increased for the group that had diagnostic tomosynthesis compared to both the groups that did not have tomosynthesis (the PT and NT groups).

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