Digital mammography: a model for assessing cost-effectiveness

Digital Mammography: Current Capabilities and Obstacles

Digital mammography represents an exciting new technology for breast imaging and possibly breast screening. The decoupling of functional components in digital mammography translates into potential operational efficiencies compared with screen-film mammography (SFM). Digital mammography is a platform for advanced applications not possible with traditional SFM. However, for digital mammography to replace SFM in daily clinical practice, operational and clinical hurdles will have to be overcome.

New modalities in breast imaging: digital mammography, positron emission tomography, and sestamibi scintimammography

Digital mammography, PET, and sestamibi scintimammography are three new modalities in breast imaging. DM has advantages over film-screen mammography in image storage, retrieval, and processing and may lower the recall rate. Computer-aided detection may increase the sensitivity of mammographic screening without a substantial reduction in specificity. Whereas PET and sestambi scintimammography are not useful in breast cancer screening, PET may play a role in detecting nodal metastases and monitoring treatment response, and sestamibi scintimammography in selected cases may serve as an adjunct to conventional imaging. The cost-effectiveness of these new modalities remains to be evaluated, but all have the potential to significantly advance the diagnosis and management of women with breast cancer.

Perspective on digital mammography

Digital mammography, particularly through its advanced applications, holds great promise for improved diagnostic accuracy, but the display of the images is not ideal at present. Clinical softcopy workstations are somewhat unwieldy to use, and image processing has not yet been optimized for each machine or for each clinical task. In addition, the cost-effectiveness and accuracy of the technology warrant careful study before digital mammography becomes widely disseminated and potentially replaces screen-film mammography, a technology that has been well documented to reduce breast cancer mortality.

What every surgical oncologist should know about digital mammography

This article reviews the available information on digital mammography for surgeons who care for patients with breast cancer. The limitations of the current film-based technology and why digital mammography promises to improve breast cancer detection and breast lesion diagnosis are described. The basics of digital imaging technology are reviewed, including a description of image contrast and spatial resolution and its variance from currently available clinical digital mammography systems. The results of clinical trials completed to date are reported. An upcoming large screening trial for digital mammography, sponsored by the National Cancer Institute, is described. Future technological developments, including improvements in softcopy display, image processing, computer-aided detection and diagnosis (CADD), tomosynthesis, and digital subtraction mammography (DSM), are briefly discussed.

Digital and Computer-Aided Mammography

Digital mammography uses an electronic system to record an image of the breast that can be stored on a computer instead of on hardcopy films. There are a number of digital mammography technologies under evaluation. The potential advantages of digital mammography include improvements in image contrast, manipulation of the image after it is performed (avoiding repeats for technical problems), elimination of lost films, reduction in film library maintenance costs, and the ability to transmit the images over long distances (telemammography). Challenges and potential problems for digital mammography include a need to prove equivalence in detection and diagnosis with conventional mammography, the high cost of digital mammography equipment, and lagging workstation technology. Computer-aided detection and diagnosis (CAD) uses analysis by a computer program to assist the interpreting physician in identifying abnormal findings on mammograms and in making a benign versus malignant diagnosis of calcifications and masses. Several studies suggest that this technology can reduce the incidence of missed cancers and improve the positive predictive value for biopsies. CAD can be performed after digitization of hardcopy films but is best suited to digitally acquired soft copy images.