Digital Breast Tomosynthesis: Initial Experience in 98 Women with Abnormal Digital Screening Mammography

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The purpose of our study was to compare the image quality of tomosynthesis with that of conventional mammography and to estimate the recall rate of screening when tomosynthesis is used in addition to mammography. Women with an abnormal screening mammography were recruited sequentially. Consenting women underwent tomosynthesis of the affected breast corresponding to the views obtained with diagnostic mammography. The study radiologist compared the image quality, including lesion conspicuity and feature analysis, of tomosynthesis with diagnostic film-screen mammography and assessed the need for recall when tomosynthesis was added to digital screening mammography. Screening recalls were considered unnecessary when tomosynthesis did not show a corresponding abnormality or allowed definitely benign lesion characterization. Fisher's exact test was used to determine the association of equivalence and recall status with mammographic finding type. There were 99 digital screening recalls in 98 women. The image quality of tomosynthesis was equivalent (n = 51) or superior (n = 37) to diagnostic mammography in 89% (88/99). Finding type was significantly (p < 0.001) associated with equivalence. Approximately half--52/99 (52%)--of the findings would not have been recalled when digital screening mammography was supplemented with tomosynthesis. When adjusting for confounding conditions, the recall reduction was 40% (37/92). The likelihood of recall was also dependent on finding type (p = 0.004). Subjectively, tomosynthesis has comparable or superior image quality to that of film-screen mammography in the diagnostic setting, and it has the potential to decrease the recall rate when used adjunctively with digital screening mammography.