title: Implementation of breast tomosynthesis in a routine screening practice: an observational study.
abstract: OBJECTIVE
  Digital mammography combined with tomosynthesis is gaining clinical acceptance, but data are limited that show its impact in the clinical environment. We assessed the changes in performance measures, if any, after the introduction of tomosynthesis systems into our clinical practice.
  
  
  METHODS
  In this observational study, we used verified practice- and outcome-related databases to compute and compare recall rates, biopsy rates, cancer detection rates, and positive predictive values for six radiologists who interpreted screening mammography studies without (n = 13,856) and with (n = 9499) the use of tomosynthesis. Two-sided analyses (significance declared at p < 0.05) accounting for reader variability, age of participants, and whether the examination in question was a baseline were performed.
  
  
  RESULTS
  For the group as a whole, the introduction and routine use of tomosynthesis resulted in significant observed changes in recall rates from 8.7% to 5.5% (p < 0.001), nonsignificant changes in biopsy rates from 15.2 to 13.5 per 1000 screenings (p = 0.59), and cancer detection rates from 4.0 to 5.4 per 1000 screenings (p = 0.18). The invasive cancer detection rate increased from 2.8 to 4.3 per 1000 screening examinations (p = 0.07). The positive predictive value for recalls increased from 4.7% to 10.1% (p < 0.001).
  
  
  CONCLUSIONS
  The introduction of breast tomosynthesis into our practice was associated with a significant reduction in recall rates and a simultaneous increase in breast cancer detection rates.
authors.affiliation: TOPS Comprehensive Breast Center, 17030 Red Oak Dr, Houston, TX 77090, USA. slrosemd@hbimaging.onmicrosoft.com
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Rose
authors.forename: Andra L
authors.initials: AL
authors.lastname: Tidwell
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Bujnoch
authors.forename: Anne C
authors.initials: AC
authors.lastname: Kushwaha
authors.forename: Amy S
authors.initials: AS
authors.lastname: Nordmann
authors.forename: Russell
authors.initials: R
authors.lastname: Sexton
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D016014:Linear Models; D008327:Mammography; D008403:Mass Screening; D008875:Middle Aged; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*