Feasibility study comparing synthesized mammography with digital breast tomosynthesis and digital mammography for simulated first round screening in a single BreastScreen NSW centre

• Published in: Journal of medical imaging and radiation oncology Vol. 68; no. 4; pp. 401 - 411
• Main Authors: Dhurandhar, Vikrant, Bhola, Nalini, Chan, Mico, Choi, Sarah, Chung, Tzu‐Yun, Giuffre, Bruno, Hunter, Nigel, Lee, Katelyn, McKessar, Merran, Reddy, Ranjani, Roberts, Marian, Shearman, Christine, Kay, Meredith, Bruderlin, Ken, Winarta, Niko, Noakes, Jennifer
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01.06.2024
• Subjects: Adult; Aged; Australia; Breast Neoplasms - diagnostic imaging; Cancer; Clients; cost; cost analysis; Cost control; Cost effectiveness; Cost reduction; Cost-Benefit Analysis; Diagnostic systems; digital breast tomosynthesis; digital mammography; Early Detection of Cancer - methods; Equivalence; Feasibility Studies; Female; Humans; mammography; Mammography - economics; Mammography - methods; Mass Screening - economics; Mass Screening - methods; Medical imaging; Middle Aged; New South Wales; Parameter sensitivity; Reading; Recall; Sensitivity and Specificity; Synthesis; Australia; New South Wales; digital breast tomosynthesis; cost; mammography; cost analysis; digital mammography
• DOI: 10.1111/1754-9485.13664
• ISSN: 1754-9477; 1754-9485

Introduction While digital breast tomosynthesis (DBT) has proven to enhance cancer detection and reduce recall rates (RR), its integration into BreastScreen Australia for screening has been limited, in part due to perceived cost implications. This study aims to assess the cost effectiveness of digital mammography (DM) compared with synthesized mammography and DBT (SM + DBT) in a first round screening context for short‐term outcomes. Methods Clients recalled for nonspecific density (NSD) as a single lesion by both readers at the Northern Sydney Central Coast BreastScreen service in 2019 were included. Prior images were excluded to simulate first‐round screening. Eleven radiologists read DM and synthesized mammography with DBT (SM + DBT) images 4 weeks apart. Recall rates (RR), reading time, and diagnostic parameters were measured, and costs for screen reading and assessment were calculated. Result Among 65 clients studied, 13 were diagnosed with cancer, with concordant cancer recalls. SM + DBT reduced recall rates (RR), increased reading time, maintained cancer detection sensitivity, and significantly improved other diagnostic parameters, particularly false positive rates. Benign biopsy recalls remained equivalent. While SM + DBT screen reading cost was significantly higher than DM (DM AU$890 ± 186 vs SM + DBT AU$1279 ± 265; P < 0.001), the assessment cost (DM AU$29,504 ± 9427 vs SM + DBT AU$18,021 ± 5606; P < 0.001), and combined screen reading and assessment costs were significantly lower (DM AU$30,394 ± 9508 vs SM + DBT AU$19,300 ± 5721; P = 0.001). SM + DBT screen reading and assessment of 65 patients resulted in noteworthy cost savings (AU$11,094), equivalent to assessing 12 additional clients. Conclusion In first round screening, DBT yields significant cost savings by effectively reducing unnecessary recalls to assessment while maintaining diagnostic efficacy.