Sunday, August 18, 2013

Adding tomosynthesis digital mammography increases the cancer detection rate

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Adding tomosynthesis digital mammography increases the cancer detection rate -

The addition of tomosynthesis, an imaging technique in 3D, mammography digital in more than 170,000 examinations was associated with a decrease in the proportion of patients recalled for additional imaging and an increased cancer detection rate, according to a study published in the June issue 25 JAMA .

screening mammography has played a key role in reducing mortality from breast cancer, even though it has been criticized for excessive false positive results, limited sensitivity, and the potential for overdiagnosis of lesions clinically insignificant. In 2011, tomosynthesis was approved by the US Food and Drug Administration for use in combination with standard digital mammography for breast cancer screening. Single-institution studies have shown that the addition of tomosynthesis to mammography increases cancer detection and reduced false positive results, according to background information in the article.

Sarah M. Friedewald, MD, of Advocate Lutheran General Hospital, Park Ridge, Il., And colleagues conducted a study using data from 13 centers to determine whether the combined mammography with tomosynthesis improves the performance of breast screening programs. A total of 454.850 examinations (n ​​= 281187 digital mammography; n = 173663 digital mammography tomosynthesis +) were evaluated

The primary outcomes measured were the recall rate (proportion of patients requiring additional imaging-based a result of the screening test). The cancer detection rates, positive predictive value for the reminder (proportion of patients recalled after screening who were diagnosed with breast cancer) and positive predictive value for biopsy (proportion of patients undergoing biopsies who were diagnosed as having breast cancer).

an analysis of the data indicated that the rate per 1,000 screens fitted model are: to recall rates, 107 with digital mammography vs 91 with digital mammography + tomosynthesis (an overall decrease in rates 16 1000 nag screens); for biopsies, 18.1 with digital mammography vs 19.3 with digital mammography tomosynthesis +; for detecting cancer with digital mammography 4.2 vs 5.4 with digital mammography tomosynthesis +; and for the detection of invasive cancer with digital mammography 2.9 vs 4.1 with digital mammography tomosynthesis +.

Add tomosynthesis increased positive predictive value for the recall of 4.3 percent to 6.4 percent and for biopsy from 24.2 percent to 29.2 percent.

"the success of mammography screening in reducing mortality is based on the principle of detecting and treating asymptomatic small cancers before they have metastasized. accordingly, the preferential increase in the detection of invasive cancer with addition of tomosynthesis may be of particular value to optimize patient outcomes of mammography screening, "the authors write.

" The association with less tests and unnecessary biopsies, with a simultaneous increase in the cancer detection rate, would support the potential benefits of tomosynthesis as a tool for screening. However, the assessment of a benefit in clinical outcomes is needed. "

There will also be a press digital news available for this study, including video Report JAMA, integrated and downloadable video, audio, text files, documents, and related links. This content will be available 15 hours CT Tuesday, June 24 at this link

Editorial:.? breast cancer Screening - If tomosynthesis Replace digital mammography

"As Friedewald et al reported, tomosynthesis is likely progress compared to digital mammography for breast cancer screening, but fundamental questions remain about screening, with all available technologies, "write Etta D. Pisano, MD, of the medical University of South Carolina, Charleston, and Martin J. Yaffe, Ph .D., University of Toronto.

"breast cancer remains a major public health problem, with approximately 40,000 American women die each year. the continuing controversy surrounding the most effective strategy for the deployment of various technologies available consensus continues unabated, and clearly lacking when on screen, how often and with what tools, or even detected cancers could be managed to more conservative. Only a multisite clinical trial fed properly controlled modern technology can answer questions remaining permanently. The time has come for the National Institutes of Health to fund such a trial as needed to answer many outstanding questions about breast cancer screening. "


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