TABLE 1:
Summary of Studies Showing Incremental Increase in Cancer Detection and Decrease in Recall Rates After Addition of DBT to DM for Evaluation of Dense and Nondense Breasts
| Finding, Breast Density, and Modality | Ciatto et al., 2013 [35]a | Rafferty et al., 2016 [43]b | Østerås et al., 2019 [42]a,c | Conant et al., 2019 [13]b | ||||
|---|---|---|---|---|---|---|---|---|
| Value | P | Value | P | Value | P | Value | P | |
| CDR per 1000 screening examinations | ||||||||
| Nondense | ||||||||
| DM and DBT | 8.4 (51/6079) | 5.1 (455/89,171) | 7.7 (122/15,785) | 5.6 (87/15,612) | ||||
| DM | 5.6 (34/6079) | 4.2 (610/146,910) | 6.0 (94/15,785) | 4.5 (301/66,664) | ||||
| Differenced | 2.8 | < 0.0001 | 0.95 | < 0.001 | 1.8 | < 0.001 | 1.1 | 0.091 |
| Dense | ||||||||
| DM and DBT | 6.6 (8/1215) | 5.8 (495/84,243) | 12.5 (106/8466) | 7.8 (73/9321) | ||||
| DM | 4.1 (5/1215) | 4.5 (597/131,996) | 9.7 (82/8466) | 5.4 (192/35,309) | ||||
| Differenced | 2.5 | 0.25 | 1.4 | < 0.001 | 2.8 | < 0.001 | 2.4 | < 0.0001 |
| Heterogeneously dense | ||||||||
| DM and DBT | NR | 6.1 (450/72,481) | 12.5 (83/6645) | NR | ||||
| DM | NR | 4.5 (528/113,290) | 9.6 (64/6645) | NR | ||||
| Differenced | 1.6 | < 0.001 | 2.9 | < 0.001 | ||||
| Extremely dense | ||||||||
| DM and DBT | NR | 3.9 (45/11,762) | 12.7 (23/1821) | NR | ||||
| DM | NR | 3.8 (69/18,706) | 9.9 (18/1821) | NR | ||||
| Differenced | 0.1 | 0.88 | 2.8 | 0.06 | ||||
| Recall rate per 1000 screening examinationse | ||||||||
| Nondense | ||||||||
| DM and DBT | 39 (233/6028) | 79 (6955/89,171) | 79 (1246/15,785) | 76 (2334/30,839) | ||||
| DM | 45 (273/6028) | 90 (12,845/146,910) | 96 (1515/15,785) | 100 (8549/85,275) | ||||
| Differenced | −6 | 0.0035 | −12 | < 0.001 | −17 | < 0.001 | −24 | < 0.001 |
| Dense | ||||||||
| DM and DBT | 66 (80/1207) | 109 (9030/84,243) | 125 (1061/8466) | 105 (2109/20,070) | ||||
| DM | 73 (88/1207) | 127 (16,582/131,996) | 133 (1126/8466) | 135 (5931/44,094) | ||||
| Differenced | −7 | 0.35 | −18 | < 0.001 | −8 | < 0.001 | −30 | < 0.0001 |
| Heterogeneously dense | ||||||||
| DM and DBT | NR | 110 (7852/72,481) | 120 (804/6645) | NR | ||||
| DM | NR | 128 (14,484/113,290) | 132 (879/6645) | NR | ||||
| Differenced | −18 | < 0.001 | −12 | < 0.001 | ||||
| Extremely dense | ||||||||
| DM and DBT | NR | 98 (1178/11,762) | 141 (257/1821) | NR | ||||
| DM | NR | 114 (2098/18,706) | 136 (247/1821) | NR | ||||
| Differenced | −16 | < 0.001 | 5 | 0.82 | ||||
Note—Nondense tissue was defined as almost entirely fatty tissue or scattered fibroglandular density, and dense tissue was defined as heterogeneously dense or extremely dense tissue. CDR = cancer detection rate, DBT = digital breast tomosynthesis, DM = 2D full-field digital mammography, NR = not reported.
Each patient had both standard DM and DBT examinations and served as her own control.
Historical controls for DM results.
Results are reported at the breast level and inferred at the participant level; one woman had bilateral breast cancer.
Difference between DM plus DBT versus DM alone.