title: False positives in breast cancer screening with one-view breast tomosynthesis: An analysis of findings leading to recall, work-up and biopsy rates in the Malmö Breast Tomosynthesis Screening Trial.
abstract: OBJECTIVE
  To analyse false positives (FPs) in breast cancer screening with tomosynthesis (BT) vs. mammography (DM).
  
  
  METHODS
  The Malmö Breast Tomosynthesis Screening Trial (MBTST) is a prospective population-based study comparing one-view BT to DM in screening. This study is based on the first half of the MBTST population (n = 7,500). Differences in FP recall rate, findings leading to recall, work-up and biopsy rate between cases recalled on BT alone, DM alone and BT+DM were analysed.
  
  
  RESULTS
  The FP recall rate was 1.7 % for BT alone (n = 131), 0.9 % for DM alone (n = 69) and 1.1 % for BT + DM (n = 81). The FP recall rate for BT alone was halved after the initial phase of the trial, stabilising at 1.5 %. BT doubled the recall of stellate distortions compared to DM (n = 64 vs. n = 33). There were fewer fibroadenomas and cysts, and the biopsy rate was slightly lower for FP recalled on BT alone compared to DM alone (15.3 % vs. 27.6 %: p = 0.037 and 33.8 % vs. 36.2 %; p = 0.641, respectively).
  
  
  CONCLUSIONS
  FPs increased with BT screening mainly due to the recall of stellate distortions. The FP recall rate was still well within the European guidelines and showed evidence of a learning curve. Characterisation of rounded lesions was improved with BT.
  
  
  CONCLUSIONS
  • Tomosynthesis screening gave a higher false-positive recall rate than mammography • There was a decline in the false-positive recall rate for tomosynthesis • The recall due to stellate distortions simulating malignancy was doubled with tomosynthesis • Tomosynthesis found more radial and postoperative scar tissue than mammography • Tomosynthesis is better at characterising rounded lesions.
authors.affiliation: Department of Medical Radiology, Translational Medicine Malmö, Lund University, Inga Marie Nilssons gata 49, SE-20502, Malmö, Sweden. kristina.lang@med.lu.se.
authors.forename: Kristina
authors.identifier: http://orcid.org/0000-0001-9250-1897
authors.initials: K
authors.lastname: Lång
authors.affiliation: Department of Medical Radiology, Translational Medicine Malmö, Lund University, Inga Marie Nilssons gata 49, SE-20502, Malmö, Sweden.
authors.forename: Matilda
authors.initials: M
authors.lastname: Nergården
authors.affiliation: Department of Medical Radiology, Translational Medicine Malmö, Lund University, Inga Marie Nilssons gata 49, SE-20502, Malmö, Sweden.
authors.forename: Ingvar
authors.initials: I
authors.lastname: Andersson
authors.affiliation: Epidemiology and Register Centre South, Skåne University Hospital, Klinikgatan 22, SE-221 85, Lund, Sweden.
authors.forename: Aldana
authors.initials: A
authors.lastname: Rosso
authors.affiliation: Department of Medical Radiology, Translational Medicine Malmö, Lund University, Inga Marie Nilssons gata 49, SE-20502, Malmö, Sweden.
authors.forename: Sophia
authors.initials: S
authors.lastname: Zackrisson
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods; D001940:Breast / Q000000981:diagnostic imaging / Q000473:pathology*; D047688:Breast Cyst / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D055088:Early Detection of Cancer; D005189:False Positive Reactions; D005260:Female; D018226:Fibroadenoma / Q000473:pathology; D006801:Humans; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies
keywords: Breast cancer; Breast tomosynthesis; Diagnostic imaging; Digital mammography; Screening