Breast cancer screening in women with and without implants: retrospective study comparing digital mammography to digital mammography combined with digital breast tomosynthesis

• Published in: European radiology Vol. 31; no. 12; pp. 9499 - 9510
• Main Authors: Cohen, Ethan O., Perry, Rachel E., Tso, Hilda H., Phalak, Kanchan A., Lesslie, Michele D., Gerlach, Karen E., Sun, Jia, Srinivasan, Ashmitha, Leung, Jessica W. T.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2021; Springer Nature B.V
• Subjects: Breast; Breast cancer; Breast implants; Breast Neoplasms - diagnostic imaging; Cancer; Cancer screening; Diagnostic Radiology; Early Detection of Cancer; Female; Humans; Imaging; Implants; Internal Medicine; Interventional Radiology; Mammography; Mammography - methods; Mass Screening; Medical screening; Medicine; Medicine & Public Health; Neuroradiology; Performance measurement; Radiology; Recall; Retrospective Studies; Statistical analysis; Ultrasound; Screening; Breast cancer; Mammography; Tomosynthesis; Breast implants
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-021-08040-3

Objectives Compare four groups being screened: women without breast implants undergoing digital mammography (DM), women without breast implants undergoing DM with digital breast tomosynthesis (DM/DBT), women with implants undergoing DM, and women with implants undergoing DM/DBT. Methods Mammograms from February 2011 to March 2017 were retrospectively reviewed after 13,201 were excluded for a unilateral implant or prior breast cancer. Patients had been allowed to choose between DM and DM/DBT screening. Mammography performance metrics were compared using chi-square tests. Results Six thousand forty-one women with implants and 91,550 women without implants were included. In mammograms without implants, DM ( n = 113,973) and DM/DBT ( n = 61,896) yielded recall rates (RRs) of 8.53% and 6.79% (9726/113,973 and 4204/61,896, respectively, p < .001), cancer detection rates per 1000 exams (CDRs) of 3.96 and 5.12 (451/113,973 and 317/61,896, respectively, p = .003), and positive predictive values for recall (PPV1s) of 4.64% and 7.54% (451/9726 and 317/4204, respectively, p < .001), respectively. In mammograms with implants, DM ( n = 6815) and DM/DBT ( n = 5138) yielded RRs of 5.81% and 4.87% (396/6815 and 250/5138, respectively, p = .158), CDRs of 2.49 and 2.92 (17/6815 and 15/5138, respectively, p > 0.999), and PPV1s of 4.29% and 6.0% (17/396 and 15/250, respectively, p > 0.999), respectively. Conclusions DM/DBT significantly improved recall rates, cancer detection rates, and positive predictive values for recall compared to DM alone in women without implants. DM/DBT performance in women with implants trended towards similar improvements, though no metric was statistically significant. Key Points • Digital mammography with tomosynthesis improved recall rates, cancer detection rates, and positive predictive values for recall compared to digital mammography alone for women without implants. • Digital mammography with tomosynthesis trended towards improving recall rates, cancer detection rates, and positive predictive values for recall compared to digital mammography alone for women with implants, but these trends were not statistically significant — likely related to sample size.