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Breast Cancer Res Treat. 2018 Jun;169(3):489-496. doi: 10.1007/s10549-018-4705-2. Epub 2018 Feb 10.

Performance of breast cancer screening using digital breast tomosynthesis: results from the prospective population-based Oslo Tomosynthesis Screening Trial.

Author information

1
Division of Radiology and Nuclear Medicine, Breast Imaging Center, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0407, Oslo, Norway. PERSKA@ous-hf.no.
2
Department of Screening, Cancer Registry of Norway, Oslo, Norway.
3
Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA.
4
Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA.
5
The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
6
Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
7
Department of Screening, Cancer Registry of Norway, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.

Abstract

PURPOSE:

Digital breast tomosynthesis (DBT) has the potential to overcome limitations of conventional mammography. This study investigated the effects of addition of DBT on interval and detected cancers in population-based screening.

METHODS:

Oslo Tomosynthesis Screening Trial (OTST) was a prospective, independent double-reading trial inviting women 50-69 years biennially, comparing full-field digital mammography (FFDM) plus DBT with FFDM alone. Performance indicators and characteristics of screen-detected and interval cancers were compared with two previous FFDM rounds.

RESULTS:

24,301 consenting women underwent FFDM + DBT screening over a 2-year period. Results were compared with 59,877 FFDM examinations during prior rounds. Addition of DBT resulted in a non-significant increase in sensitivity (76.2%, 378/496, vs. 80.8%, 227/281, p = 0.151) and a significant increase in specificity (96.4%, 57229/59381 vs. 97.5%, 23427/24020, p < .001). Number of recalls per screen-detected cancer decreased from 6.7 (2530/378) to 3.6 (820/227) with DBT (p < .001). Cancer detection per 1000 women screened increased (6.3, 378/59877, vs. 9.3, 227/24301, p < .001). Interval cancer rate per 1000 screens for FFDM + DBT remained similar to previous FFDM rounds (2.1, 51/24301 vs. 2.0, 118/59877, p = 0.734). Interval cancers post-DBT were comparable to prior rounds but significantly different in size, grade, and node status from cancers detected only using DBT. 39.6% (19/48) of interval cancers had positive nodes compared with only 3.9% (2/51) of additional DBT-only-detected cancers.

CONCLUSIONS:

DBT-supplemented screening resulted in significant increases in screen-detected cancers and specificity. However, no significant change was observed in the rate, size, node status, or grade of interval cancers. ClinicalTrials.gov: NCT01248546.

KEYWORDS:

Breast cancer screening; Breast neoplasms; Digital breast tomosynthesis; Interval breast cancer; Mammography

PMID:
29429017
DOI:
10.1007/s10549-018-4705-2
[Indexed for MEDLINE]

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