While research has demonstrated the benefits of supplemental digital breast tomosynthesis (DBT) in population-based breast cancer screening, a new study suggests that DBT has limited value for women at higher risk of breast cancer.
For the prospective study, recently published in the European Journal of Radiology, researchers compared full-field digital mammography (FFDM) to the combination of FFDM and DBT in 429 asymptomatic women (mean age of 51) with and elevated risk of breast cancer. Factors indicating an elevated breast cancer risk included dense breasts (61 percent of the cohort), a family history of breast cancer (68 percent had a first-degree relative with breast cancer) or prior biopsy-confirmed lobular carcinoma in situ or atypical ductal hyperplasia, according to the study.
Out of seven cases of breast cancer detected in the study, the researchers found that four were diagnosed with FFDM and no additional cancers were detected with supplemental DBT. In the remaining cases missed by FFDM and DBT, ultrasound and magnetic resonance imaging (MRI) both detected two of the cases and MRI diagnosed the other case of breast cancer, according to the study authors.
“The low performance of DBT in this higher-than-average risk population and the need for additional (ultrasound) and MRI is consistent with the recommendations from the ACR in (breast cancer) screening,” wrote lead author Machteld Keupers, M.D., who is affiliated with the Department of Radiology at University Hospitals KU Leuven in Leuven, Belgium, and colleagues.
The researchers also noted equivalent sensitivity for FFDM and the use of supplemental DBT for three of the four reviewing radiologists, and an overall sensitivity rate of 57 percent for the combination of FFDM and DBT in this patient population. The combination of FFDM and DBT had a positive predictive value (PPV) of 36 percent, according to the study authors. They also noted no significant differences in accuracy between FFDM and the combination of FFDM and DBT.
Three Key Takeaways
- Limited efficacy of DBT in high-risk populations: The study found that DBT did not detect any additional cases of breast cancer compared to full-field digital mammography (FFDM) alone in women with an elevated risk of breast cancer, indicating limited value of DBT as a supplementary screening tool for this population.
- Need for additional imaging modalities. Due to the low performance of DBT, the study suggests the necessity of using additional imaging modalities such as ultrasound and magnetic resonance imaging (MRI) for effective breast cancer detection in higher-risk women in line with American College of Radiology (ACR) recommendations.
- Caution due to higher radiation dose. Given that the combination of FFDM and DBT results in a higher radiation dose than FFDM alone, the study advises careful selection of high-risk groups to ensure that the benefits of the additional radiation exposure outweigh the risks.
Noting that other research has shown lower effectiveness of DBT for women with higher breast cancer risk and/or dense breasts, the authors suggested a cautious approach with the use of DBT.
“Since FFDM + DBT has a somewhat higher radiation dose than FFDM alone, it is important that the high BC risk group is selected as accurately as possible to justify the additional radiation,” added Keupers and colleagues.
(Editor’s note: For related content, see “Study: Abbreviated MRI and DBT Offer Comparable Breast Cancer Detection in Dense Breasts,” “Mammography Study: AI Improves Breast Cancer Detection and Reduces Reading Time with DBT” and “Current Insights and Emerging Roles for Contrast-Enhanced Mammography.”)
Beyond the inherent limitations of a single-center study, the authors acknowledged the small number of cancer cases in the cohort, the use of one DBT system and the subjective nature of visual assessment for breast density.
