ARRS: Diagnostic breast tomo reduces need for US, biopsies

By Kate Madden Yee, AuntMinnie.com staff writer

May 5, 2014 -- Using breast tomosynthesis in diagnostic workup -- specifically, with one- or two-view focal asymmetries found at screening mammography -- reduces ultrasound use and leads to fewer biopsies compared to diagnostic mammography alone, according to research presented at the American Roentgen Ray Society (ARRS) meeting in San Diego.

The technology also contributes to a higher positive predictive value for cancer detection, researchers from the University of Virginia in Charlottesville reported.

Much research has been conducted regarding breast tomosynthesis' use in breast cancer screening, but not so much for diagnostic applications, said lead researcher Dr. Brandi Nicholson.

Dr. Brandi Nicholson
Dr. Brandi Nicholson from the University of Virginia.

"Tomosynthesis has been evaluated in screening populations and been shown to decrease recall rates, but studies in the diagnostic setting are lacking," she said in a statement released by ARRS.

Nicholson and colleagues analyzed 294 patients who were recalled for a focal asymmetric density discovered at screening across two categories: those who did not have tomosynthesis at diagnostic evaluation (No DBT), and those who had diagnostic tomosynthesis (Yes DBT). There were 145 patients in the No DBT group and 149 in the Yes DBT group.

"We had recently installed a tomosynthesis unit in our practice, and made the decision as a group to start using it in the diagnostic setting," Nicholson told AuntMinnie.com.

The researchers recorded each woman's age, menopausal status, and breast density, and they compared the type of views obtained (full and/or spot compression), whether ultrasound was performed, and the positive predictive value (PPV) for any biopsy performed between the groups.

They found that additional full views, spot compression views, and ultrasound exams were performed less frequently in the group that received tomosynthesis compared to the group that had no tomosynthesis.

As for the positive predictive value of BI-RADS 4 lesions, the rate was 5% for the No DBT group and 14.3% for the Yes DBT group. The PPV for BI-RADS 4 and 5 lesions together was higher in the group that underwent tomosynthesis, at 66.7%, compared with 17.4% in the No DBT group.

Incorporating tomosynthesis in the diagnostic side of clinical practice has a number of benefits, Nicholson told AuntMinnie.com.

"Even though our study cohort was small, we did see an improvement in PPV when tomosynthesis was included in the diagnostic workup, and also less biopsies," she said. "This is good news, since we're all trying to find more disease without subjecting women to more tests."


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