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Digital Breast Tomosynthesis 3D Mammography Trudi Parker M.D.

Digital Breast Tomosynthesis

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Digital Breast Tomosynthesis3D Mammography

Trudi Parker M.D.

Breast Cancer Statistics

ACS Estimates for 2014

Most common cancer among American women

232,670 new cases of breast cancer diagnosed in women

2nd. Leading cause of cancer death in women, exceeded only by lung cancer

40,000 women will die from breast cancer

5-Year Relative Survival by Stage at Diagnosis

www.seer.cancer.gov

SEER 18 2004-2010, All Races, Females by SEER Summary Stage 2000

Hologic

Hologic

Limitations of 2D Mammography

20% of cancers will be missed

Sensitivity decreases significantly with increased breast density

Approximately 10% will be recalled for additional work up

75-80% of all breast biopsies will result in benign results

2D versus 3D Mammography

Enhanced lesion detection – borders of lesion better defined

Increased cancer detection rate

Reduces false positive recalls

Precise lesion localization

Technique: 2D and 3D images obtained with

one compression

X-ray tube sweeps through a 15deg

arc acquiring 15 low dose

projections (~4secs)

Mathematical reconstruction

generates 1mm slices through the

breast

Radiation dose: ~2X the dose of a

mammogram

Still very low, below MQSA

requirements

C-view (synthesized 2D)

2D will no longer be needed

Dose reduction

Hologic

Hologic

Limitations of DBT

Takes longer to read

Cannot be read on demand or STAT

Increased radiation

Radiation dose: ~2X the dose of a mammogram

Still very low, below MQSA requirements

No CPT code

Massive storage requirements

IT Storage Requirements for 20,000

Mammograms

2D Storage for standard 4 View Mammogram = 1.74 Terabytes/year

3D Storage for standard 4 View Mammogram = 10 Terabytes/year

2D 3DHologic

Hologic

Reducing False Positives

Oslo Norway DBT

Screening Trial

Prospective Trial : November 22,2010 to December 31,2011

4 Arms: 2D, 2D +CAD, 2D+3D, synthesized 2D+3D

12,621 sequentially recruited women

Exams interpreted with mammography alone and compared with

mammography + DBT

Oslo Norway DBT

Screening Trial

Results:

Cancer Detection Rate of Invasive Cancer +DCIS

27% increase (p=.001)

40% Increase detection of invasive cancers

Increase observed across all breast densities

2D Mammography alone: 6.1 cancers/1000 exams

2D + Tomosynthesis : 8 cancers/1000 exams

Oslo Norway DBT

Screening Trial

Results:

False Positives ( Recalls from screening exams)

Mammography alone : 61.1/1000 exams

Mammography + Tomosynthesis : 53.1/1000

15% Decrease

JAMA

Retrospective Trial : March 2010 – December 2012

454,850 examinations

13 sites (academic and nonacademic)

Compared mammography interpretation performance 1 year prior to

tomosynthesis implementation to performance following

tomosynthesis implementation

JAMA

Results:

454,850 examinations

281,187 2D exams

173,663 2D+3D exams

Recall Rate: 15%

Cancer Detection Rate: 41% (invasive cancers)

DCIS detection rate : no change

JAMA

Results:

PPV for recall : 49%

PPV for biopsy : 21%

56 year old , screening exam

The Breast Density Legislation

Effective August 1, 2014, a new law by the Minnesota State Legislature

requires all Minnesota mammography facilities to report breast density to

patients with dense breasts. This law was enacted for three reasons:

1. Dense breasts slightly decrease the ability of mammography to find

breast cancer.

2. Dense breasts slightly increase the risk of breast cancer.

3. Patients may want to know about supplemental screening tests.

Supplemental Screening Options

Breast MRI

Expensive

Requires IV contrast

Recommended for select hi risk population (>20% lifetime risk of breast cancer)

Screening US

Slightly increased cancer detection but has high false positives

Operator dependent, time consuming

Digital Breast Tomosynthesis

Only mammography has been shown to decrease mortality rates.

Summary

Summary Digital Breast Tomosynthesis

Build on the success of the the

screening mammogram

Increased Sensitivity AND

Specificity

Right sizing breast imaging

Replace 2D MammographyAllina website

THANK YOU