title: Incremental effect from integrating 3D-mammography (tomosynthesis) with 2D-mammography: Increased breast cancer detection evident for screening centres in a population-based trial.
abstract: OBJECTIVE
  Three-dimensional (3D)-mammography (tomosynthesis) may improve breast cancer detection. We examined centre-specific effect of integrated 2D/3D mammography based on the STORM (screening with tomosynthesis or standard mammography) trial.
  
  
  METHODS
  Asymptomatic women who attended population-based screening through Trento and Verona screening centres were recruited into STORM, a prospective comparison of screen-reading in two sequential phases: 2D-mammography only and integrated 2D/3D mammography. Outcomes were the number and rates of detected cancers and of false positive recalls (FPR), and incremental cancer detection rate (CDR). Paired binary data were compared using Mc Nemar's test.
  
  
  RESULTS
  Of 33 cancers detected in Trento, 21 were detected at both 2D and 2D/3D screening, 12 cancers were detected only with integrated 2D/3D screening compared with none detected at 2D-only screening (P < 0.001). Of the 26 cancers detected in Verona, 18 were detected at both 2D and 2D/3D screening, 8 cancers were detected only with integrated 2D/3D screening compared with none detected at 2D-only screening (P = 0.008). There were no differences between centres in baseline CDR, and incremental CDR attributable to 3D-mammography was similar for Trento (2.8/1000 screens) and for Verona (2.6/1000 screens). Trento had 239 FPR (5.7% of screens): 103 FPR at both screen-readings, 93 FPR only at 2D-mammography compared with 43 FPR only at 2D/3D-mammography (p < 0.001). Verona had 156 FPR (5.2% of screens): 78 FPR at both screen-readings, 48 FPR only at 2D-mammography compared with 30 FPR only at 2D/3D-mammography (p = 0.054). Estimated reduction in FPR proportion had recall been conditional to 2D/3D-mammography-positivity differed between centres (21.0% versus 11.5%; P = 0.02).
  
  
  CONCLUSIONS
  Integrated 2D/3D-mammography significantly increased cancer detection for both screening services; potential reduction in FPR is likely to differ between centres with those experiencing relatively higher FPR most likely to benefit from 2D/3D-mammography screening.
authors: Centro di Prevenzione Senologica, Marzana, Verona, Italy.
authors: Francesca
authors: F
authors: Caumo
authors: U.O. Senologia Clinica e Screening Mammografico, Department of Diagnostics, Azienda Provinciale Servizi Sanitari (APSS), Trento, Italy.
authors: Daniela
authors: D
authors: Bernardi
authors: Centro di Prevenzione Senologica, Marzana, Verona, Italy; U.O. Senologia Clinica e Screening Mammografico, Department of Diagnostics, Azienda Provinciale Servizi Sanitari (APSS), Trento, Italy.
authors: Stefano
authors: S
authors: Ciatto
authors: Screening and Test Evaluation Program (STEP), School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia.
authors: Petra
authors: P
authors: Macaskill
authors: U.O. Senologia Clinica e Screening Mammografico, Department of Diagnostics, Azienda Provinciale Servizi Sanitari (APSS), Trento, Italy.
authors: Marco
authors: M
authors: Pellegrini
authors: Centro di Prevenzione Senologica, Marzana, Verona, Italy.
authors: Silvia
authors: S
authors: Brunelli
authors: U.O. Senologia Clinica e Screening Mammografico, Department of Diagnostics, Azienda Provinciale Servizi Sanitari (APSS), Trento, Italy.
authors: Paola
authors: P
authors: Tuttobene
authors: Centro di Prevenzione Senologica, Marzana, Verona, Italy.
authors: Paola
authors: P
authors: Bricolo
authors: U.O. Senologia Clinica e Screening Mammografico, Department of Diagnostics, Azienda Provinciale Servizi Sanitari (APSS), Trento, Italy.
authors: Carmine
authors: C
authors: Fantò
authors: U.O. Senologia Clinica e Screening Mammografico, Department of Diagnostics, Azienda Provinciale Servizi Sanitari (APSS), Trento, Italy.
authors: Marvi
authors: M
authors: Valentini
authors: Centro di Prevenzione Senologica, Marzana, Verona, Italy.
authors: Stefania
authors: S
authors: Montemezzi
authors: Screening and Test Evaluation Program (STEP), School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia. Electronic address: nehmath@med.usyd.edu.au.
authors: Nehmat
authors: N
authors: Houssami
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D002277:Carcinoma / Q000000981:diagnostic imaging*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D012680:Sensitivity and Specificity
keywords: Digital breast tomosynthesis; Mammography; Population cancer screening