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Hologic The Women's Health Company
Recent Clinical Studies on 3D Mammography (Breast Tomosynthesis) Strongly Supports Its Use in Screening and Diagnostics Indications
3d Mammography

Hologic's 3D mammography (breast tomosynthesis) technology is getting significant attention in the scientific community this year. Thirty presentations on 3D mammography were presented at the Radiological Society of North America (RSNA) meeting in November.

» View the bibliography of 115 published studies.
PubMed, the scientific research database of the U.S. National Center for Biotechnology Information (NCBI), lists hundreds of published studies on "breast tomosynthesis." This AuntMinnie eBroadcast looks at the findings of six recent peer-reviewed clinical studies as listed in PubMed.

Comparison of Digital Mammography Alone and Digital Mammography Plus Tomosynthesis in a Population-based Screening Program. Skaane P, Bandos AI, Gullien R, Eben EB, Ekseth U, Haakenaasen U, Izadi M, Jebsen IN, Jahr G, Krager M, Niklason LT, Hofvind S, Gur D. Radiology. 2013 Jan 7 [Epub ahead of print].

The addition of 3D mammography to traditional 2D screening significantly increased the number of invasive breast cancers found across all populations of women in the first large-scale, prospective clinical study comparing the addition of 3D (tomosynthesis) mammography to traditional 2D digital mammography alone.

The study, published online in advance of print on the Radiology website, was designed to determine if 3D screening would find cancers that would be missed by 2D screening alone.
Number of Invasive Cancers Detected
The study of more than 12,600 women showed a 40 percent increase in the detection or identification of invasive cancers, along with a 15 percent decrease in false positives.

Notably, this increase in invasive cancers detection was found across all breast tissue compositions, both dense and fatty. At the same time, there was no increase in the detection of ductal carcinoma in situ (DCIS), which is noninvasive and is often cited by critics of screening mammography as being overdiagnosed.

» PubMed Write Up  |  » Q&A  |  » AuntMinnie article
Assessing Radiologist Performance Using Combined Digital Mammography and Breast Tomosynthesis Compared with Digital Mammography Alone: Results of a Multicenter, Multireader Trial. Rafferty EA, Park JM, Philpotts LE, Poplack SP, Sumkin JH, Halpern EF, Niklason LT. Radiology. 2013 Jan;266(1):104-13. doi: 10.1148/radiol.12120674. Epub 2012 Nov 20.

The diagnostic accuracy of combined tomosynthesis and digital mammography is superior to digital mammography alone according to a study published in the January 2013 issue of Radiology.
Dr. Elizabeth Rafferty of Mass General Hospital and her colleagues report that the addition of tomosynthesis to digital mammography offers the dual benefit of significantly increased diagnostic accuracy and significantly reduced recall rates for noncancer cases.

The paper covers the results of two reader studies: Study 1 included 12 radiologists that evaluated 312 cases of which 48 were cancer cases. Study 2 included 15 radiologists that evaluated 312 cases of which 51 were cancer cases. Study 1 readers recorded only those cases that had an abnormality and needed to be recalled. Study 2 readers also recorded the lesion type and its location.

Study 2 included 15 radiologists that evaluated 312 cases of which 51 were cancer cases. Study 2 readers recorded the lesion type and its location.

ROC analysis was used to determine the radiologist’s diagnostic accuracy. BI-RADS score was used to determine the recall rate for noncancer cases, specificity, sensitivity, positive and negative predictive values for the two methods.

» PubMed Write Up  |  » RSNA: Radiology Website  |  » AuntMinnie article
Digital Breast Tomosynthesis versus Supplemental Diagnostic Mammographic Views for Evaluation of Noncalcified Breast Lesions. Zuley ML, Bandos AI, Ganott MA, Sumkin JH, Kelly AE, Catullo VJ, Rathfon GY, Lu AH, Gur D. Radiology. 2013 Jan;266(1):89-95. doi: 10.1148/radiol.12120552. Epub 2012 Nov 9.

3D mammography is more accurate than mammography for working up suspicious findings on screening exams, which could translate into fewer recalls and unnecessary biopsies, researchers from Pittsburgh report in the January 2013 issue of Radiology.

Lead author Dr. Margarita Zuley and her colleagues from the University of Pittsburgh compared the diagnostic performance of breast tomosynthesis to supplemental mammography in the classification of masses, distortions, and asymmetries. The group found that when radiologists used tomosynthesis, they rated fewer benign masses as probably or definitely malignant — BI-RADS categories 3, 4, or 5 — without a loss of sensitivity.

"In clinical practice, the results of this study suggest that use of tomosynthesis is likely to translate into fewer recalled screening examinations, fewer short-interval follow-up studies, and fewer biopsies in patients with benign lesions," Zuley and her colleagues wrote.

» PubMed Write Up  |  » RSNA: Radiology Website  |  » AuntMinnie article
Prospective Study of Breast Tomosynthesis as a Triage to Assessment in Screening. Bernardi D, Ciatto S, Pellegrini M, Tuttobene P, Fanto' C, Valentini M, Michele SD, Peterlongo P, Houssami N. Breast Cancer Res Treat. 2012 May;133(1):267-71. doi: 10.1007/s10549-012-1959-y. Epub 2012 Jan 22.

Radiologists adding breast tomosynthesis to 2D mammography screenings reduced the recall rate by 74 percent compared with conventional 2D digital mammography in a population-based breast screening program, Italian researchers found in a study in Breast Cancer Research and Treatment.

Dr. Daniela Bernardi from the breast screening clinic at Trentino Health Administration (APSS) in Trento, Italy, led the study of 158 women recalled after initial baseline 2D mammography. The team assessed each woman with both standard mammography and tomosynthesis.

In all, 102 of the cases were negative with both imaging modalities, another 21 were positive with both, and the remaining 35 were positive with tomosynthesis but negative with standard mammography. Tomosynthesis would have avoided recall in 74.4 percent of the recalled women who had a negative or benign final outcome (102/137), the investigators concluded.

» PubMed Write Up  |  » AuntMinnieEurope article
Can Digital Breast Tomosynthesis Replace Conventional Diagnostic Mammography Views for Screening Recalls Without Calcifications? A Comparison Study in a Simulated Clinical Setting. Brandt KR, Craig DA, Hoskins TL, Henrichsen TL, Bendel EC, Brandt SR, Mandrekar J. AJR Am J Roentgenol. 2013 Feb;200(2):291-8. doi: 10.2214/AJR.12.8881.

3D mammography could replace conventional diagnostic mammography for further workup of noncalcified lesions found on screening mammography, according to a study published in the February 2013 issue of the American Journal of Roentgenology.

Researchers from the Mayo Clinic in Rochester, MN, found no significant difference between breast tomosynthesis and diagnostic mammography in terms of sensitivity, specificity, or accuracy. Using 3D mammography instead of conventional mammography could not only reduce the time required, it could also perhaps reduce a woman's radiation exposure from additional mammographic views acquired during workup.

One hundred forty-six women, with 158 abnormalities, underwent diagnostic mammography and two-view breast tomosynthesis. Three radiologists viewed the abnormal screening mammograms, comparison mammograms, and tomosynthesis images and recorded a tomosynthesis BI-RADS category and confidence score for each finding. Readers did not view the diagnostic mammograms. A final tomosynthesis BI-RADS category, incorporating ultrasound results in some cases, was determined and compared with the diagnostic mammography BI-RADS category using kappa statistics. Sensitivity and specificity were calculated for breast tomosynthesis and diagnostic mammography.

» PubMed Write Up  |  » AJR Website  |  » AuntMinnie article
Value of One-view Breast Tomosynthesis Versus Two-view Mammography in Diagnostic Workup of Women with Clinical Signs and Symptoms and in Women Recalled from Screening. Waldherr C, Cerny P, Altermatt HJ, Berclaz G, Ciriolo M, Buser K, Sonnenschein MJ. AJR Am J Roentgenol. 2013 Jan;200(1):226-31. doi: 10.2214/AJR.11.8202.

Among patients with abnormal mammograms, one-view breast tomosynthesis showed better sensitivity and negative predictive value than 2D digital mammography for those with fatty and dense breasts, according to a study published in the January 2013 issue of the American Journal of Roentgenology.

Dr. Christian Waldherr, from the Breast Center Bern in Switzerland, and colleagues compared the diagnostic value of one-view breast tomosynthesis to two-view digital mammography alone, as well as to a combined reading of both modalities. Their goal was to see if breast tomosynthesis has a role in daily clinical practice in terms of working up women with suspicious mammograms.

In patients with abnormal mammograms, one-view digital breast tomosynthesis had better sensitivity and negative predictive value than did conventional 2D mammography in patients with fatty and dense breasts.

Eighty-six of the 144 patients in the study were found to have breast cancer. The BI-RADS categories for one-view breast tomosynthesis were significantly better than those for two-view digital mammography (p < 0.001) and were equal to those of the combined reading in both women admitted for diagnostic workup and women recalled from screening.

The sensitivity and negative predictive values of digital breast tomosynthesis were superior to those of 2D digital mammography in fatty and dense breasts overall and in women admitted for diagnostic workup and in women recalled from screening. Only 11 percent of digital breast tomosynthesis examinations required additional imaging, compared with 23 percent of the 2D digital mammography cases.

» PubMed Write Up  |  » AJR Website  |  » AuntMinnie article

New 3D Mammography Websites You Can Use

3D Mammography for Patients

Written for patients and their doctors, Hologic3D.com is an easy new way to promote public awareness and educate patients about 3D mammography. The site contains a zip code based site finder, information on when to be screened, and current articles, videos, white papers, and press releases on breast tomosynthesis.

Breast Tomosynthesis for Doctors, Administrators, and Technologists

Redesigned and totally updated, BreastTomo.com contains the latest informational available on the clinical and business benefits of breast tomosynthesis.

Applied Radiology - Breast Tomosynthesis Webinar Series
February 12 Breast Tomosynthesis
Part 1: Where we are and where we're going

In the first part of a two-part webinar series, Dr. Liane Philpotts, Professor of Diagnostic Radiology and Chief of Breast Imaging, and Dr. Melissa Durand, Assistant Professor of Diagnostic Radiology, from the Yale School of Medicine, will share their experience working with breast tomosynthesis in the clinical setting. Part 1 will discuss:

The impact on recall rates and cancer detection of using breast tomosynthesis in screening mammography.
The impact of breast tomosynthesis on diagnostic workups.
Patient cases comparing conventional mammography with conventional mammography plus breast tomosynthesis.
March 19 Breast Tomosynthesis
Part 2: Incorporating it in your practice

In the part 2 of the breast tomosynthesis webinar series, Doctors Philpotts and Durand discuss:

How to incorporating breast tomosynthesis into a screening and diagnostic mammography practice.
Dealing with patients' concerns regarding radiation dose.
Managing changes in workflow.

Archived Webinars from ICPME on Tomosynthesis (YouTube)
Digital Breast Tomosynthesis Case Study: Calcifications, Lymph Nodes, and Stable Masses
Linda Greer, MD
John C. Lincoln Breast Health and Research Center – Deer Valley Hospital, Phoenix, Arizona

» Watch video

Digital Breast Tomosynthesis Case Study: Occult Radial Scar, ILC in Fatty Breast Tissue
Linda Greer, MD
John C. Lincoln Breast Health and Research Center – Deer Valley Hospital, Phoenix, Arizona

» Watch video

Digital Breast Tomosynthesis Case Study: Breast Tomosynthesis May Reduce False Positives
Stephen Rose, MD
Houston Breast Imaging, Houston, Texas

» Watch video

Digital Breast Tomosynthesis Case Study: Fatty-Replaced Breast
Stephen Rose, MD
Houston Breast Imaging, Houston, Texas

» Watch video

   Educational Opportunities

Hologic both offers and supports many comprehensive educational programs and events that provide clinicians the opportunity to learn the most up-to-date information in their field and gain hands-on experience on the most technologically advanced tools available in women's health.

The programs we support are taught by experienced medical professionals and address both the academic as well as the practical aspects of working in women's health.
Archived Webinars from ICPME*

Bone Densitometry

Breast MRI CASE Series for Radiologists

Breast Tomosynthesis

Prostate Webinar Case Review

Stereotactic Breast Biopsy

Ultrasound-Guided Breast Biopsy

Learn more about Hologic Medical Education offerings.

Upcoming Breast Tomosynthesis Workshops & Symposiums

Breast Tomosynthesis Workshops for Physicians CME*
Individual full-day sessions
March 7, 2013 (adjacent to BI3 — 2013 Conference)
Las Vegas, Nevada

Breast Tomosynthesis Workshops for Physicians CME*
Individual full-day sessions
March 23, 24, or 25, 2013
New York, New York
Hologic Live Technologist Training

Positioning in Mammography Matters & Radiation Concerns
April 11, 2013
Bedford, Massachusetts

Understanding Breast Tomosynthesis
April 12, 2013
Bedford, Massachusetts

Stereotactic Breast Biopsy: Prone & Upright Procedural Tracks
April 18, 2013
Bedford, Massachusetts

The Basics of Breast Tomosynthesis
April 20, 2013
Santa Clara, California

Master DXA: Workshops to Improve Your Skills & Grow Your Practice
May 9, 2013
Bedford, Massachusetts

Breast MRI Course for Technologists
May 11, 2013
Bedford, Massachusetts

Click here for more information or to register for the above courses.

European Congress of Radiology 2013: Breast Tomosynthesis for Breast Cancer Screening and Diagnosis
Hologic is offering three special tomosynthesis-related events at ECR in Vienna, March 8 to 11.

A satellite symposium titled "Evolution of Breast Tomosynthesis: from Research to Large-scale, Population-based Screening Programs to Advanced Applications" on Saturday, March 9th.
Nine 45-minute breast tomosynthesis education sessions from March 7th thru the 10th. Each session include hands-on experience reading 3D breast tomosynthesis images in combination with conventional and synthesized 2D images.
Eight tomosynthesis biopsy workshops on Friday, March 8th, and Saturday, March 9th.
For additional information and registration information, please email Tomoinfo@hologic.com.

Other Upcoming Hands-on Tomosynthesis (3D Mammography) Workshops:

13-15 — Johannesburg, South Africa
24 — Tokyo, Japan

7-11 — Vienna, Austria (ECR)
20-21 — Tel Aviv, Israel
29-31 — SuZhou, JiangSu Province, China (Digital Mammography only)
4 — London, UK
5-6 — Helsinki, Finland
11-12 — Bordeaux, France
19-21 — German (Erlangen Congress)
25-26 — Castricum, Netherlands
29-May 1 — Sao Paulo, Brazil
To register and for program details, please contact tomo.courses@hologic.com. In your note, be sure to indicate the course date and location of interest.
*Programs are supported by Hologic with an unrestricted educational grant.

This newsletter is intended for medical professionals and/or specific product users residing in the United States and other countries and should not be considered as a solicitation or promotion of any product or of an indication of any product that is not authorized by the laws and regulations of another country where the reader resides. This newsletter could refer to products that are or may not be available in any particular country, and/or may not have received market clearance by a governmental regulatory body for indications and restrictions in different countries.
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