%0 Journal Article
%T Digital Breast Tomosynthesis Changes Management in Patients Seen at a Tertiary Care Breast Center
%A L. Margolies
%A A. Cohen
%A E. Sonnenblick
%A J. Mandeli
%A P. H. Schmidt
%A J. Szabo
%A N. Patel
%A G. Hermann
%A C. Weltz
%A E. Port
%J ISRN Radiology
%D 2014
%R 10.1155/2014/658929
%X Objectives. To study factors that predict changes in management with digital breast tomosynthesis (DBT). Methods. The Institutional Review Board approved this HIPAA compliant study. 996 patients had DBT with full field digital mammography (FFDM). Univariate analysis evaluated predictors of management change and cancer detection. Results. DBT changed management in 109 of 996 (11%); 77 (71%) required less imaging. Recalled patients after abnormal FFDM screen were most likely to have management change〞25% (24 of 97 patients) compared to 8% (13/163) of symptomatic patients and 10% (72/736) of screening patients ( ). Dense breasted patients had a higher likelihood of having DBT change management: 13% (68/526) compared to 9% (41/470) ( ). Of the 996 patients, 19 (2%) were diagnosed with breast cancer. 15 cancers (83%) were seen on FFDM and DBT; 3 (17%) were diagnosed after DBT (0.3%, 95%CI: 0.1每0.9%). One recurrence was in the skin and was not seen on DBT nor was it seen on FFDM. The increase in cancer detection rate was 17% for asymptomatic patients, 0% for symptomatic patients, and 100% for recalled patients. Conclusions. DBT increased cancer detection rate by 20% and decreased the recall rate in 8每25%. Advances in Knowledge. DBT led to a doubling of the cancer detection rate in recalled patients. 1. Introduction Prospective trials of screening mammography demonstrate a reduction in breast cancer mortality [1, 2] yet concerns regarding false positive and false negative findings generate controversy [3]. In parallel with efforts to define populations who may benefit from supplemental ultrasound or MRI screening [4每8] technical innovations to improve mammography＊s sensitivity and specificity have included full field digital mammography (FFDM) [9, 10], computer aided detection (CAD) [11], and digital breast tomosynthesis (DBT) [12]. DBT images potentially reduce false positives caused by overlapping tissues which can mimic cancer while simultaneously reducing false negatives caused by tissue overlap which could obscure malignancy. Thus, DBT improves the sensitivity of screening mammography compared with FFDM while decreasing recall rates [13每15]. Much work investigating DBT, however, has been retrospective or performed on enriched data sets [16每18] and there are few studies on the role of DBT in populations at elevated risk for breast cancer. In a meta-analysis of 14 studies, no data was available regarding the clinical variables associated with enhanced cancer detection by DBT [13]. Here, we investigated groups of patients for whom DBT altered management. We
%U http://www.hindawi.com/journals/isrn.radiology/2014/658929/