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Tomosynthesis Significantly Reduces Breast Cancer Screening Recall Rate

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Based on a new study published online in the journal Radiology, tomosynthesis was found to be a highly effective digital tool for decreasing the recall rate in breast cancer screening.

mammography" href="/tag/Digital-mammography.html">Digital mammography has grown to become the highest standard for breast cancer screening, but may yield suspicious findings that turn out not to be cancer. These false-positive discoveries are related to a higher recall rate, or the rate at which women are called back for further imaging or biopsy.

Digital breast tomosynthesis has exhibited much promise in reducing recall rates, predominantly in younger women and in those with dense breast tissue. Tomosynthesis resembles a mammography in the sense that it depends on ionizing radiation to produce images of the breast. However, unlike traditional mammography, tomosynthesis allows for three-dimensional (3-D) reconstruction of the breast tissue, which can then be viewed as chronological slices through the breast. tomosynthesis recall rate

"Tomosynthesis increases the conspicuity of cancers by removing superimposed and overlapping tissue from the view," said Brian M. Haas, M.D., from Yale University School of Medicine in New Haven, Conn.

For the study, Haas collaborated with Liane E. Philpotts, M.D., who is also from Yale University, and other researchers to compare and contrast screening recall rates and cancer detection rates in two groups of women. The first group comprises of those who have solely received conventional digital mammography, compared to those who had tomosynthesis alongside a mammography.

From the 13,158 patients who were given a screened mammography, 6,100 received tomosynthesis. The cancer detection rate was 5.7 per 1,000 in patients who had been given tomosynthesis, compared to 5.2 per 1,000 in patients who were only given a mammography. The inclusion of tomosynthesis resulted in a 30 percent reduction in the overall recall rate, from 12.0 percent for mammography alone to 8.4 percent in the tomosynthesis group.

"All age groups and breast densities had reduced risk for recall in the tomosynthesis group. Women with dense breasts and those younger than age 50 particularly benefited from tomosynthesis. Lower recall rates help reduce patient anxiety and also reduce costs from additional diagnostic examinations,” said Haas.

Yet tomosynthesis is riddled with problems of its own. For instance, the radiation doses found in tomosynthesis approximately double that of digital mammography alone. Yet as Haas points out, the recent technology has earned approval by the U.S. Food and Drug Administration (FDA) which could lead to a reduction in radiation dosage.

"The technology involves taking the tomosynthesis data and collapsing it into planar imaging that resembles 2-D mammography. It has the potential to eliminate the need for acquisition of the conventional 2-D images in addition to the tomosynthesis images,” said Haas.

For now the research team is busy comparing the cancers discovered by tomosynthesis with those discovered by mammography. They are also tracking the study group for interval cancers, those that develop in the interval between screenings to ensure that the reduced recall rate linked to tomosynthesis is not resulting in undetected cancers.

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