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Jögi A, Johnson K, Wittgren S, Sundgren V, Tomic H, Olinder J, Åkesson A, Andersson I, Zackrisson S, Bakic PR. Assessing Digital Breast Tomosynthesis Impact on Early Cancer Detection: Insights from Consecutive Screening. Radiology 2024; 312:e233417. [PMID: 39078298 DOI: 10.1148/radiol.233417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Background Analysis of how digital breast tomosynthesis (DBT) screening affects consecutive screening performance is important to estimate its future value in screening. Purpose To evaluate whether DBT contributes to early detection of breast cancer by assessing cancer detection rates (CDRs), including the fraction of invasive cancers and cancer subtypes in consecutive routine digital mammography (DM). Materials and Methods The paired prospective Malmö Breast Tomosynthesis Screening Trial (MBTST) was performed between January 2010 and February 2015. Participating women underwent one-view DBT and two-view DM at one screening occasion. In this secondary analysis, women were followed up through their first (DM1) and second (DM2) consecutive two-view DM screening rounds after MBTST participation. Cancer diagnoses were identified by referencing records. A logistic regression model, adjusted for age, was used to calculate the odds of luminal A-like cancers with use of the MBTST as reference. Results There were 14 848 final participants in the MBTST (median age, 57 years [IQR, 49-65 years]). Of those, 12 876 women were screened in DM1 (median age, 58 years [IQR, 50-66 years]) and 10 883 were screened in DM2 (median age, 59 years [IQR, 51-67 years]). Compared with CDRs in the trial of 6.5 of 1000 women (95% CI: 5.2, 7.9) for DM and 8.7 of 1000 women (95% CI: 7.3, 10.3) for DBT, the CDR was lower in DM1 (4.6 of 1000 women [95% CI: 3.6, 5.9]) and DM2 (5.3 of 1000 women [95% CI: 4.1, 6.9]). The proportion of invasive cancers was 84.9% (118 of 139 cancers) in the MBTST; the corresponding numbers were 66% (39 of 59 cancers) for DM1 and 83% (50 of 60 cancers) for DM2. The odds of luminal A-like cancers were lower in DM1 at 0.28 (95% CI: 0.12, 0.66 [P = .004]) but not in DM2 at 0.80 (95% CI: 0.40, 1.58 [P = .52]) versus screening in the MBTST. Conclusion CDR and the fraction of invasive cancers were lower in DM1 and then increased in DM2 following the MBTST, indicating earlier cancer detection mainly due to increased detection of luminal A-like cancers in DBT screening. Clinical trials registration no. NCT01091545 © RSNA, 2024 See also the editorial by Hooley and Philpotts in this issue.
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Affiliation(s)
- Annika Jögi
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Kristin Johnson
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Sofia Wittgren
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Victor Sundgren
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Hanna Tomic
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Jakob Olinder
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Anna Åkesson
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Ingvar Andersson
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Sophia Zackrisson
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Predrag R Bakic
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
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Johnson K, Olinder J, Rosso A, Andersson I, Lång K, Zackrisson S. False-positive recalls in the prospective Malmö Breast Tomosynthesis Screening Trial. Eur Radiol 2023; 33:8089-8099. [PMID: 37145147 PMCID: PMC10597871 DOI: 10.1007/s00330-023-09705-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/20/2023] [Accepted: 03/25/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVES To evaluate the total number of false-positive recalls, including radiographic appearances and false-positive biopsies, in the Malmö Breast Tomosynthesis Screening Trial (MBTST). METHODS The prospective, population-based MBTST, with 14,848 participating women, was designed to compare one-view digital breast tomosynthesis (DBT) to two-view digital mammography (DM) in breast cancer screening. False-positive recall rates, radiographic appearances, and biopsy rates were analyzed. Comparisons were made between DBT, DM, and DBT + DM, both in total and in trial year 1 compared to trial years 2 to 5, with numbers, percentages, and 95% confidence intervals (CI). RESULTS The false-positive recall rate was higher with DBT, 1.6% (95% CI 1.4; 1.8), compared to screening with DM, 0.8% (95% CI 0.7; 1.0). The proportion of the radiographic appearance of stellate distortion was 37.3% (91/244) with DBT, compared to 24.0% (29/121) with DM. The false-positive recall rate with DBT during trial year 1 was 2.6% (95% CI 1.8; 3.5), then stabilized at 1.5% (95% CI 1.3; 1.8) during trial years 2 to 5. The percentage of stellate distortion with DBT was 50% (19/38) trial year 1 compared to 35.0% (72/206) trial years 2 to 5. CONCLUSIONS The higher false-positive recall rate with DBT compared to DM was mainly due to an increased detection of stellate findings. The proportion of these findings, as well as the DBT false-positive recall rate, was reduced after the first trial year. CLINICAL RELEVANCE STATEMENT Assessment of false-positive recalls gives information on potential benefits and side effects in DBT screening. KEY POINTS • The false-positive recall rate in a prospective digital breast tomosynthesis screening trial was higher compared to digital mammography, but still low compared to other trials. • The higher false-positive recall rate with digital breast tomosynthesis was mainly due to an increased detection of stellate findings; the proportion of these findings was reduced after the first trial year.
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Affiliation(s)
- Kristin Johnson
- Department of Translational Medicine, Radiology Diagnostics, Lund University, Malmö, Sweden.
- Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden.
| | - Jakob Olinder
- Department of Translational Medicine, Radiology Diagnostics, Lund University, Malmö, Sweden
- Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden
| | - Aldana Rosso
- Department of Clinical Sciences, Geriatric Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Ingvar Andersson
- Department of Translational Medicine, Radiology Diagnostics, Lund University, Malmö, Sweden
- Unilabs Mammography Unit, Skåne University Hospital, Malmö, Sweden
| | - Kristina Lång
- Department of Translational Medicine, Radiology Diagnostics, Lund University, Malmö, Sweden
- Unilabs Mammography Unit, Skåne University Hospital, Malmö, Sweden
| | - Sophia Zackrisson
- Department of Translational Medicine, Radiology Diagnostics, Lund University, Malmö, Sweden
- Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden
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