title: Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study.
abstract: BACKGROUND
  Digital breast tomosynthesis with 3D images might overcome some of the limitations of conventional 2D mammography for detection of breast cancer. We investigated the effect of integrated 2D and 3D mammography in population breast-cancer screening.
  
  
  METHODS
  Screening with Tomosynthesis OR standard Mammography (STORM) was a prospective comparative study. We recruited asymptomatic women aged 48 years or older who attended population-based breast-cancer screening through the Trento and Verona screening services (Italy) from August, 2011, to June, 2012. We did screen-reading in two sequential phases-2D only and integrated 2D and 3D mammography-yielding paired data for each screen. Standard double-reading by breast radiologists determined whether to recall the participant based on positive mammography at either screen read. Outcomes were measured from final assessment or excision histology. Primary outcome measures were the number of detected cancers, the number of detected cancers per 1000 screens, the number and proportion of false positive recalls, and incremental cancer detection attributable to integrated 2D and 3D mammography. We compared paired binary data with McNemar's test.
  
  
  RESULTS
  7292 women were screened (median age 58 years [IQR 54-63]). We detected 59 breast cancers (including 52 invasive cancers) in 57 women. Both 2D and integrated 2D and 3D screening detected 39 cancers. We detected 20 cancers with integrated 2D and 3D only versus none with 2D screening only (p<0.0001). Cancer detection rates were 5.3 cancers per 1000 screens (95% CI 3.8-7.3) for 2D only, and 8.1 cancers per 1000 screens (6.2-10.4) for integrated 2D and 3D screening. The incremental cancer detection rate attributable to integrated 2D and 3D mammography was 2.7 cancers per 1000 screens (1.7-4.2). 395 screens (5.5%; 95% CI 5.0-6.0) resulted in false positive recalls: 181 at both screen reads, and 141 with 2D only versus 73 with integrated 2D and 3D screening (p<0.0001). We estimated that conditional recall (positive integrated 2D and 3D mammography as a condition to recall) could have reduced false positive recalls by 17.2% (95% CI 13.6-21.3) without missing any of the cancers detected in the study population.
  
  
  CONCLUSIONS
  Integrated 2D and 3D mammography improves breast-cancer detection and has the potential to reduce false positive recalls. Randomised controlled trials are needed to compare integrated 2D and 3D mammography with 2D mammography for breast cancer screening.
  
  
  BACKGROUND
  National Breast Cancer Foundation, Australia; National Health and Medical Research Council, Australia; Hologic, USA; Technologic, Italy.
authors.affiliation: UO Senologia Clinica e Screening Mammografico, Department of Diagnostics, Azienda Provinciale Servizi Sanitari, Trento, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ciatto
authors.forename: Nehmat
authors.initials: N
authors.lastname: Houssami
authors.forename: Daniela
authors.initials: D
authors.lastname: Bernardi
authors.forename: Francesca
authors.initials: F
authors.lastname: Caumo
authors.forename: Marco
authors.initials: M
authors.lastname: Pellegrini
authors.forename: Silvia
authors.initials: S
authors.lastname: Brunelli
authors.forename: Paola
authors.initials: P
authors.lastname: Tuttobene
authors.forename: Paola
authors.initials: P
authors.lastname: Bricolo
authors.forename: Carmine
authors.initials: C
authors.lastname: Fantò
authors.forename: Marvi
authors.initials: M
authors.lastname: Valentini
authors.forename: Stefania
authors.initials: S
authors.lastname: Montemezzi
authors.forename: Petra
authors.initials: P
authors.lastname: Macaskill
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D055088:Early Detection of Cancer / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D014057:Tomography, X-Ray Computed