title: Impact on the recall rate of digital breast tomosynthesis as an adjunct to digital mammography in the screening setting. A double reading experience and review of the literature.
abstract: OBJECTIVE
  To estimate the impact on recall rate (RR) of digital breast tomosynthesis (DBT) associated with digital mammography (DM+DBT), compared to DM alone, evaluate the impact of double reading (DR) and review the literature.
  
  
  METHODS
  Ethics committees approved this multicenter study. Patients gave informed consent. Women recalled from population-based screening reading were included. Reference standard was histology and/or ≥ 1 year follow up. Negative multiple assessment was considered for patients lost at follow up. Two blinded readers (R1, R2) evaluated first DM and subsequently DM+DBT. RR, sensitivity, specificity, accuracy, positive and negative predictive values (PPV, NPV), were calculated for R1, R2, and DR. Cohen κ and χ(2) were used for R1-R2 agreement and RR related to breast density.
  
  
  RESULTS
  We included 280 cases (41 malignancies, 66 benign lesions, and 173 negative examinations). The RR reduction was 43% (R1), 58% (R2), 43% (DR). Sensitivity, specificity, accuracy, PPV and NPV were: 93%, 67%, 71%, 33%, 98% for R1; 88%, 73%, 75%, 36%, 97% for R2; 98%, 55%, 61%, 27%, 99% for DR. The agreement was higher for DM+DBT (κ=0.459 versus κ=0.234). Reduction in RR was independent from breast density (p=0.992).
  
  
  CONCLUSIONS
  DBT was confirmed to reduce RR, as shown by 13 of 15 previous studies (reported reduction 6-82%, median 31%). This reduction is confirmed when using DR. DBT allows an increased inter-reader agreement.
authors.affiliation: Radiology Unit, Research Hospital Policlinico San Donato, San Donato Milanese, Milan, Italy.
authors.forename: Luca A
authors.initials: LA
authors.lastname: Carbonaro
authors.affiliation: Radiology Unit, Research Hospital Policlinico San Donato, San Donato Milanese, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Leo
authors.affiliation: Institute of Radiology, Department of Medical and Biological Sciences, University of Udine, Udine, Italy; Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Austria. Electronic address: clauser.p@hotmail.it.
authors.forename: Paola
authors.initials: P
authors.lastname: Clauser
authors.affiliation: Radiology Unit, Research Hospital Policlinico San Donato, San Donato Milanese, Milan, Italy.
authors.forename: Rubina M
authors.initials: RM
authors.lastname: Trimboli
authors.affiliation: Radiology Unit, Research Hospital Policlinico San Donato, San Donato Milanese, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Verardi
authors.affiliation: Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy.
authors.forename: Maria P
authors.initials: MP
authors.lastname: Fedeli
authors.affiliation: Institute of Radiology, Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
authors.forename: Rossano
authors.initials: R
authors.lastname: Girometti
authors.affiliation: Unità Operativa di Senologia, Ospedale Maggiore, AUSL Bologna, Bologna, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Tafà
authors.affiliation: Unità Operativa di Senologia, Ospedale Maggiore, AUSL Bologna, Bologna, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Bruscoli
authors.affiliation: Unità Operativa di Senologia, Ospedale Maggiore, AUSL Bologna, Bologna, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Saguatti
authors.affiliation: Institute of Radiology, Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Bazzocchi
authors.affiliation: Radiology Unit, Research Hospital Policlinico San Donato, San Donato Milanese, Milan, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sardanelli
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000379:methods; D001940:Breast / Q000473:pathology; D047688:Breast Cyst / Q000000981:diagnostic imaging / Q000473:pathology; D000071060:Breast Density; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D018226:Fibroadenoma / Q000000981:diagnostic imaging / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D064847:Multimodal Imaging / Q000706:statistics & numerical data*; D015588:Observer Variation; D011159:Population Surveillance; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods*; D012680:Sensitivity and Specificity; D014056:Tomography, X-Ray / Q000706:statistics & numerical data
keywords: Breast cancer; Digital breast tomosynthesis (DBT); Digital mammography (DM); Recall rate; Screening; population based