Alberto S Tagliafico1, Giovanna Mariscotti2, Francesca Valdora3, Manuela Durando2, Jacopo Nori4, Daniele La Forgia5, Ilan Rosenberg6, Francesca Caumo7, Nicoletta Gandolfo8, Maria Pia Sormani9, Alessio Signori9, Massimo Calabrese10, Nehmat Houssami11. 1. Department of Health Sciences (DISSAL), Radiology Section, University of Genova, Via Pastore, 1-16132, Genova, Italy; Emergency Radiology, Policlinico San Martino, Largo Rosanna Benzi, 10-16132, Genova, Italy. Electronic address: alberto.tagliafico@unige.it. 2. Azienda Ospedaliera Universitaria Citta Della Salute e Della Scienza di Torino, Via Ventimiglia, 1-10126, Torino, Italy. 3. Department of Health Sciences (DISSAL), Radiology Section, University of Genova, Via Pastore, 1-16132, Genova, Italy. 4. Azienda Ospedaliero-Universitaria Carreggi, Largo Brambilla, 3-50134, Firenze, Italy. 5. SSD Radiodiagnostica Senologica-IRCCS Istituto Tumori Bari "Giovanni Paolo II", Via O. Flacco, 65-70124, Bari, Italy. 6. Unit of Radiology, San Bartolomeo Hospital, ASL 5 "Spezzino", Via Cisa Loc. Santa Caterina, 19038, Sarzana, Italy. 7. Veneto Institute of Oncology IOV - IRCCS, Via Gattamelata, 64-35128, Padua, Italy. 8. Department of Imaging, ASL 3 Genovese, SC Radiologia - P.O. Villa Scassi Via Onofrio Scassi, 1-16125, Genova, Italy. 9. Department of Health Sciences (DISSAL), University of Genova, Via Pastore 1-16132, Genova, Italy. 10. Breast Radiology, Policlinico San Martino, Largo Rosanna Benzi, 10-16132, Genova, Italy. 11. Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, 2006, Australia. Electronic address: Nehmat.houssami@sydney.edu.au.
Abstract
BACKGROUND: Increased risk of breast cancer (BC) and increased risk of an interval BC at mammography screening are associated with high mammographic density. Adjunct imaging detects additional BCs not detected at mammography screening in women with dense breasts. AIM: The aim is to estimate the incremental cancer detection rate (CDR) and false-positive recall for each of tomosynthesis and ultrasound, as adjunct screening modalities in women with mammography-negative dense breasts. METHODS: A multicentre prospective comparative trial of adjunct screening with tomosynthesis or ultrasound in women with mammography-negative dense breasts (ASTOUND-2) recruited asymptomatic women attending Italian breast screening services. All participants had independently interpreted tomosynthesis and ultrasound. Outcomes were ascertained from excision histopathology or completed assessment. Paired binary data were compared using McNemar's test. RESULTS: We recruited 5300 screening participants with median age of 50 (interquartile range 43-79) years who had negative mammography and dense breasts (April 2015-September 2017). Adjunct screening detected 29 additional BCs (27 invasive, 2 in situ): 12 detected on both tomosynthesis and ultrasound, 3 detected only on tomosynthesis, 14 detected only on ultrasound. Incremental CDR for tomosynthesis (+15 cancers) was 2.83/1000 screens (95% confidence interval [CI]: 1.58-4.67) versus ultrasound (+26 cancers) with an incremental CDR of 4.90/1000 screens (95% CI: 3.21-7.19), P = 0.015. Mean size of these cancers was 14.2 mm (standard deviation: 7.8 mm), and six had nodal metastases. Incremental false-positive recall was 1.22% (95% CI: 0.91%-1.49%) and differed significantly between tomosynthesis (0.30%) and ultrasound (1.0%), P < 0.001. CONCLUSIONS: Ultrasound detected more BCs but caused more false positives than tomosynthesis, underscoring trade-offs in screening outcomes when adjunct imaging is used for screening dense breasts.
BACKGROUND: Increased risk of breast cancer (BC) and increased risk of an interval BC at mammography screening are associated with high mammographic density. Adjunct imaging detects additional BCs not detected at mammography screening in women with dense breasts. AIM: The aim is to estimate the incremental cancer detection rate (CDR) and false-positive recall for each of tomosynthesis and ultrasound, as adjunct screening modalities in women with mammography-negative dense breasts. METHODS: A multicentre prospective comparative trial of adjunct screening with tomosynthesis or ultrasound in women with mammography-negative dense breasts (ASTOUND-2) recruited asymptomatic women attending Italian breast screening services. All participants had independently interpreted tomosynthesis and ultrasound. Outcomes were ascertained from excision histopathology or completed assessment. Paired binary data were compared using McNemar's test. RESULTS: We recruited 5300 screening participants with median age of 50 (interquartile range 43-79) years who had negative mammography and dense breasts (April 2015-September 2017). Adjunct screening detected 29 additional BCs (27 invasive, 2 in situ): 12 detected on both tomosynthesis and ultrasound, 3 detected only on tomosynthesis, 14 detected only on ultrasound. Incremental CDR for tomosynthesis (+15 cancers) was 2.83/1000 screens (95% confidence interval [CI]: 1.58-4.67) versus ultrasound (+26 cancers) with an incremental CDR of 4.90/1000 screens (95% CI: 3.21-7.19), P = 0.015. Mean size of these cancers was 14.2 mm (standard deviation: 7.8 mm), and six had nodal metastases. Incremental false-positive recall was 1.22% (95% CI: 0.91%-1.49%) and differed significantly between tomosynthesis (0.30%) and ultrasound (1.0%), P < 0.001. CONCLUSIONS: Ultrasound detected more BCs but caused more false positives than tomosynthesis, underscoring trade-offs in screening outcomes when adjunct imaging is used for screening dense breasts.
Authors: Charlotte Ezratty; Suzanne Vang; Jordonna Brown; Laurie R Margolies; Lina Jandorf; Jenny J Lin Journal: Breast Cancer Res Treat Date: 2020-05-11 Impact factor: 4.872
Authors: Wendie A Berg; Elizabeth A Rafferty; Sarah M Friedewald; Carrie B Hruska; Habib Rahbar Journal: AJR Am J Roentgenol Date: 2020-12-23 Impact factor: 3.959
Authors: Kathryn P Lowry; Rebecca Yates Coley; Diana L Miglioretti; Karla Kerlikowske; Louise M Henderson; Tracy Onega; Brian L Sprague; Janie M Lee; Sally Herschorn; Anna N A Tosteson; Garth Rauscher; Christoph I Lee Journal: JAMA Netw Open Date: 2020-07-01
Authors: Michela Franchini; Stefania Pieroni; Edgardo Montrucchio; Jacopo Nori Cucchiari; Cosimo Di Maggio; Enrico Cassano; Brunella Di Nubila; Gian Marco Giuseppetti; Alberto Nicolucci; Gianfranco Scaperrotta; Paolo Belli; Sonia Santicchia; Sabrina Molinaro Journal: Int J Environ Res Public Health Date: 2021-03-02 Impact factor: 3.390