Digital Breast Tomosynthesis: sensitivity for cancer in younger symptomatic women

Patsy Whelehan; Kulsam Ali; Sarah Vinnicombe; Graham Ball; Julie Cox; Paul Farry; Maggie Jenkin; Keith Lowry; Stuart A. McIntosh; Rachel Nutt; Rachel Oeppen; Michael Reilly; Michael  Stahnke; Jim Steel; Yee Ting Sim; Violet Warwick; Louise Wilkinson; Dimitrios Zafeiris; Andrew J. Evans

doi:10.1259/bjr.20201105

Digital Breast Tomosynthesis: sensitivity for cancer in younger symptomatic women

Patsy Whelehan (Lead / Corresponding author), Kulsam Ali, Sarah Vinnicombe, Graham Ball, Julie Cox, Paul Farry, Maggie Jenkin, Keith Lowry, Stuart A. McIntosh, Rachel Nutt, Rachel Oeppen, Michael Reilly, Michael Stahnke, Jim Steel, Yee Ting Sim, Violet Warwick, Louise Wilkinson, Dimitrios Zafeiris, Andrew J. Evans

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Abstract

Objective: Full-field digital mammography (FFDM) has limited sensitivity for cancer in younger women with denser breasts. Digital breast tomosynthesis (DBT) can reduce the risk of cancer being obscured by overlying tissue. The primary study aim was to compare the sensitivity of FFDM, DBT and FFDM-plus-DBT in women under 60 years old with clinical suspicion of breast cancer.

Methods: This multicentre study recruited 446 patients from UK breast clinics. Participants underwent both standard FFDM and DBT. A blinded retrospective multireader study involving 12 readers and 300 mammograms (152 malignant and 148 benign cases) was conducted.

Results: Sensitivity for cancer was 86.6% with FFDM [95% CI (85.2-88.0%)], 89.1% with DBT [95% CI (88.2-90%)], and 91.7% with FFDM+DBT [95% CI (90.7-92.6%)]. In the densest breasts, the maximum sensitivity increment with FFDM +DBT over FFDM alone was 10.3%, varying by density measurement method. Overall specificity was 81.4% with FFDM [95% CI (80.5-82.3%)], 84.6% with DBT [95% CI (83.9-85.3%)], and 79.6% with FFDM +DBT [95% CI (79.0-80.2%)]. No differences were detected in accuracy of tumour measurement in unifocal cases.

Conclusions: Where available, DBT merits first-line use in the under 60 age group in symptomatic breast clinics, particularly in women known to have very dense breasts. ADVANCES IN KNOWLEDGE: This study is one of very few to address the accuracy of DBT in symptomatic rather than screening patients. It quantifies the diagnostic gains of DBT in direct comparison with standard digital mammography, supporting informed decisions on appropriate use of DBT in this population.

Original language	English
Article number	20201105
Journal	British Journal of Radiology
Volume	94
Issue number	1119
Early online date	7 Jan 2021
DOIs	https://doi.org/10.1259/bjr.20201105
Publication status	Published - 2021

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Whelehan, P., Ali, K., Vinnicombe, S., Ball, G., Cox, J., Farry, P., Jenkin, M., Lowry, K., McIntosh, S. A., Nutt, R., Oeppen, R., Reilly, M., Stahnke, M., Steel, J., Sim, Y. T., Warwick, V., Wilkinson, L., Zafeiris, D., & Evans, A. J. (2021). Digital Breast Tomosynthesis: sensitivity for cancer in younger symptomatic women. British Journal of Radiology, 94(1119), Article 20201105. https://doi.org/10.1259/bjr.20201105

@article{f9fbd1e40aac433eafaea0a6cbfb9994,

title = "Digital Breast Tomosynthesis: sensitivity for cancer in younger symptomatic women",

abstract = "Objective: Full-field digital mammography (FFDM) has limited sensitivity for cancer in younger women with denser breasts. Digital breast tomosynthesis (DBT) can reduce the risk of cancer being obscured by overlying tissue. The primary study aim was to compare the sensitivity of FFDM, DBT and FFDM-plus-DBT in women under 60 years old with clinical suspicion of breast cancer.Methods: This multicentre study recruited 446 patients from UK breast clinics. Participants underwent both standard FFDM and DBT. A blinded retrospective multireader study involving 12 readers and 300 mammograms (152 malignant and 148 benign cases) was conducted.Results: Sensitivity for cancer was 86.6% with FFDM [95% CI (85.2-88.0%)], 89.1% with DBT [95% CI (88.2-90%)], and 91.7% with FFDM+DBT [95% CI (90.7-92.6%)]. In the densest breasts, the maximum sensitivity increment with FFDM +DBT over FFDM alone was 10.3%, varying by density measurement method. Overall specificity was 81.4% with FFDM [95% CI (80.5-82.3%)], 84.6% with DBT [95% CI (83.9-85.3%)], and 79.6% with FFDM +DBT [95% CI (79.0-80.2%)]. No differences were detected in accuracy of tumour measurement in unifocal cases.Conclusions: Where available, DBT merits first-line use in the under 60 age group in symptomatic breast clinics, particularly in women known to have very dense breasts. ADVANCES IN KNOWLEDGE: This study is one of very few to address the accuracy of DBT in symptomatic rather than screening patients. It quantifies the diagnostic gains of DBT in direct comparison with standard digital mammography, supporting informed decisions on appropriate use of DBT in this population.",

author = "Patsy Whelehan and Kulsam Ali and Sarah Vinnicombe and Graham Ball and Julie Cox and Paul Farry and Maggie Jenkin and Keith Lowry and McIntosh, {Stuart A.} and Rachel Nutt and Rachel Oeppen and Michael Reilly and Michael Stahnke and Jim Steel and Sim, {Yee Ting} and Violet Warwick and Louise Wilkinson and Dimitrios Zafeiris and Evans, {Andrew J.}",

note = "Funding Information: The equipment upgrade required for the study was funded, for the lead site only, by Ninewells Cancer Campaign. Further small grants to support the running of the study were provided by Tenovus, the Sir John Fisher Foundation, and a local fundraiser for the lead site, Mrs Fiona Edwards. None of the funders had input to the design or reporting of the study. The study was supported in-kind by the University of Dundee, by the host NHS organisations, and by the NHS clinical research support services and networks in England, Scotland and Northern Ireland. Publisher Copyright: {\textcopyright} 2021 The Authors. Published by the British Institute of Radiology",

year = "2021",

doi = "10.1259/bjr.20201105",

language = "English",

volume = "94",

journal = "British Journal of Radiology",

issn = "0007-1285",

publisher = "British Institute of Radiology",

number = "1119",

}

Whelehan, P, Ali, K, Vinnicombe, S, Ball, G, Cox, J, Farry, P, Jenkin, M, Lowry, K, McIntosh, SA, Nutt, R, Oeppen, R, Reilly, M, Stahnke, M, Steel, J, Sim, YT, Warwick, V, Wilkinson, L, Zafeiris, D & Evans, AJ 2021, 'Digital Breast Tomosynthesis: sensitivity for cancer in younger symptomatic women', British Journal of Radiology, vol. 94, no. 1119, 20201105. https://doi.org/10.1259/bjr.20201105

TY - JOUR

T1 - Digital Breast Tomosynthesis

T2 - sensitivity for cancer in younger symptomatic women

AU - Whelehan, Patsy

AU - Ali, Kulsam

AU - Vinnicombe, Sarah

AU - Ball, Graham

AU - Cox, Julie

AU - Farry, Paul

AU - Jenkin, Maggie

AU - Lowry, Keith

AU - McIntosh, Stuart A.

AU - Nutt, Rachel

AU - Oeppen, Rachel

AU - Reilly, Michael

AU - Stahnke, Michael

AU - Steel, Jim

AU - Sim, Yee Ting

AU - Warwick, Violet

AU - Wilkinson, Louise

AU - Zafeiris, Dimitrios

AU - Evans, Andrew J.

N1 - Funding Information: The equipment upgrade required for the study was funded, for the lead site only, by Ninewells Cancer Campaign. Further small grants to support the running of the study were provided by Tenovus, the Sir John Fisher Foundation, and a local fundraiser for the lead site, Mrs Fiona Edwards. None of the funders had input to the design or reporting of the study. The study was supported in-kind by the University of Dundee, by the host NHS organisations, and by the NHS clinical research support services and networks in England, Scotland and Northern Ireland. Publisher Copyright: © 2021 The Authors. Published by the British Institute of Radiology

PY - 2021

Y1 - 2021

N2 - Objective: Full-field digital mammography (FFDM) has limited sensitivity for cancer in younger women with denser breasts. Digital breast tomosynthesis (DBT) can reduce the risk of cancer being obscured by overlying tissue. The primary study aim was to compare the sensitivity of FFDM, DBT and FFDM-plus-DBT in women under 60 years old with clinical suspicion of breast cancer.Methods: This multicentre study recruited 446 patients from UK breast clinics. Participants underwent both standard FFDM and DBT. A blinded retrospective multireader study involving 12 readers and 300 mammograms (152 malignant and 148 benign cases) was conducted.Results: Sensitivity for cancer was 86.6% with FFDM [95% CI (85.2-88.0%)], 89.1% with DBT [95% CI (88.2-90%)], and 91.7% with FFDM+DBT [95% CI (90.7-92.6%)]. In the densest breasts, the maximum sensitivity increment with FFDM +DBT over FFDM alone was 10.3%, varying by density measurement method. Overall specificity was 81.4% with FFDM [95% CI (80.5-82.3%)], 84.6% with DBT [95% CI (83.9-85.3%)], and 79.6% with FFDM +DBT [95% CI (79.0-80.2%)]. No differences were detected in accuracy of tumour measurement in unifocal cases.Conclusions: Where available, DBT merits first-line use in the under 60 age group in symptomatic breast clinics, particularly in women known to have very dense breasts. ADVANCES IN KNOWLEDGE: This study is one of very few to address the accuracy of DBT in symptomatic rather than screening patients. It quantifies the diagnostic gains of DBT in direct comparison with standard digital mammography, supporting informed decisions on appropriate use of DBT in this population.

AB - Objective: Full-field digital mammography (FFDM) has limited sensitivity for cancer in younger women with denser breasts. Digital breast tomosynthesis (DBT) can reduce the risk of cancer being obscured by overlying tissue. The primary study aim was to compare the sensitivity of FFDM, DBT and FFDM-plus-DBT in women under 60 years old with clinical suspicion of breast cancer.Methods: This multicentre study recruited 446 patients from UK breast clinics. Participants underwent both standard FFDM and DBT. A blinded retrospective multireader study involving 12 readers and 300 mammograms (152 malignant and 148 benign cases) was conducted.Results: Sensitivity for cancer was 86.6% with FFDM [95% CI (85.2-88.0%)], 89.1% with DBT [95% CI (88.2-90%)], and 91.7% with FFDM+DBT [95% CI (90.7-92.6%)]. In the densest breasts, the maximum sensitivity increment with FFDM +DBT over FFDM alone was 10.3%, varying by density measurement method. Overall specificity was 81.4% with FFDM [95% CI (80.5-82.3%)], 84.6% with DBT [95% CI (83.9-85.3%)], and 79.6% with FFDM +DBT [95% CI (79.0-80.2%)]. No differences were detected in accuracy of tumour measurement in unifocal cases.Conclusions: Where available, DBT merits first-line use in the under 60 age group in symptomatic breast clinics, particularly in women known to have very dense breasts. ADVANCES IN KNOWLEDGE: This study is one of very few to address the accuracy of DBT in symptomatic rather than screening patients. It quantifies the diagnostic gains of DBT in direct comparison with standard digital mammography, supporting informed decisions on appropriate use of DBT in this population.

U2 - 10.1259/bjr.20201105

DO - 10.1259/bjr.20201105

M3 - Article

C2 - 33411577

SN - 0007-1285

VL - 94

JO - British Journal of Radiology

JF - British Journal of Radiology

IS - 1119

M1 - 20201105

ER -

Digital Breast Tomosynthesis: sensitivity for cancer in younger symptomatic women

Abstract

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