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DOI: 10.1055/a-2216-1109
Breast

Breast cancer screening with digital breast tomosynthesis: Is independent double reading still required?

Article in several languages: English | deutsch
Stefanie Weigel 
1   Clinic for Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
,
Hans-Werner Hense
2   Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
,
Veronika Weyer-Elberich
3   Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
,
Joachim Gerss 
3   Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
,
Walter Heindel 
1   Clinic for Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
› Author AffiliationsDeutsche Forschungsgemeinschaft (DFG) HE 1646/5-1, HE 1646/5-2
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Abstract

Purpose The European guidelines recommend independent double reading in mammography screening programs. The prospective randomized controlled trial TOSYMA tested the superiority of digital breast tomosynthesis and synthetic mammography (DBT+SM) over digital mammography (DM) for invasive breast cancer detection. This sub-analysis compares the true-positive readings of screening-detected breast cancers resulting from independent double readings in the two trial arms.

Materials and Methods The 1:1 randomized TOSYMA trial was executed in 17 screening units between 07/2018 and 12/2020. This sub-analysis included 49,762 women in the test arm (DBT+SM) and 49,796 women in the control arm (DM). The true-positive reading results (invasive breast cancers and ductal carcinoma in situ) from 83 readers were determined and merged in a double reading result.

Results DBT+SM screening detected 416 women with breast cancer and DM screening detected 306. Double readings of DBT+SM examinations led to a single true-positive together with a single false-negative result in 26.9 % of cancer cases (112/416), and in 22.2 % of cases (68/306) in the DM examinations. The cancer detection rate with discordant reading results was 2.3 per 1,000 women screened with DBT+SM and 1.4 per 1,000 with DM. Discordant reading results occurred most often for invasive breast cancers [DBT+SM 75.9 % (85/112), DM 67.6 % (46/68)], category T1 [DBT+SM 67.9 % (76/112), DM 55.9 % (38/68)], and category 4a [DBT+SM: 67.6 % (73/112); DM: 84.6 % (55/68)].

Conclusion The higher breast cancer detection rate with DBT screening includes a relevant percentage of breast cancers that were only detected by one reader in an independent double reading. As in digital mammography, independent double reading continues to be justified in screening with digital breast tomosynthesis.

Key Points 

  • The percentages of discordant cancer reading results were 26.9 % and 22.2 % for DBT+SM and DM, respectively.

  • The single true-positive detection rate was 2.3 ‰ for DBT+ SM and 1.4 ‰ for DM.

  • A relevant proportion of screening-detected cancers resulted from a single true-positive reading.

Citation Format

  • Weigel S, Hense HW, Weyer-Elberich V et al. Breast cancer screening with digital breast tomosynthesis: Is independent double reading still required?. Fortschr Röntgenstr 2024; DOI: 10.1055/a-2216-1109

Key words

breast cancer - digital breast tomosynthesis - independant double reading - screening


Publication History

Received: 25 August 2023

Accepted: 15 November 2023

Article published online:
31 January 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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