Digital breast tomosynthesis: implications for mammographic practice

Digital breast tomosynthesis (DBT) or 3D mammography is an advanced form of mammography that uses multiple low dose x-ray system and computer reconstructions to create 3D images of the breast. This is achieved by moving the x-ray tube in an arc while making a series of exposures with the overall dose comparable to a conventional 2D mammogram. This technique has rapidly emerged as an important imaging tool. It reduces the masking effect of overlapping fibroglandular tissue mimicking or obscuring lesions and facilitates differentiation between malignant and non- malignant features, especially in mammographically dense breasts.

Research suggests that 2D mammography, with the addition of DBT, has the potential to improve the accuracy of screening mammography by reducing screening recall rates and increasing cancer detection rates. Such studies include the OSLO and STORM trials. These reported a 27-34% increase in the cancer detection rates across all breast densities and a 15-17% decrease in false-positive recall rate using DBT adjunct to 2D mammography. To address the concern of almost double the radiation dose as a consequence of 2D and additional DBT a synthetic 2D image can now be created from the tomosynthesis data and research has moved on to evaluate the accuracy of this.

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