Digital tomosynthesis enhances accuracy of breast cancer detection

For more than 50 years, radiologists have screened women for breast cancer using 2-D mammography, a low-energy X-ray imaging technology that aids diagnosis, and also sometimes leads to false alarms and “callbacks” for further screening.

Now, thanks to a new technology, accuracy is improving. In a little more than two years, digital breast tomosynthesis, or 3-D mammography, is significantly reducing callbacks while picking up more cancers. It’s working so well that all eligible patients who visit the Yale Breast Center (YBC) for mammography are receiving tomosynthesis in addition to 2-D mammography. The results, says Liane E. Philpotts, M.D., professor of diagnostic radiology and chief of breast imaging for the YBC at Smilow Cancer Hospital at Yale-New Haven, have outpaced expectations.

“We’ve seen a 20 percent increase in cancer detection rates over 2-D mammography,” Philpotts says. Before tomosynthesis was used, YBC radiologists were calling back more than 10 percent of all women. With tomosynthesis, that number has been reduced by 30 percent.

The procedure was approved by the U.S. Food and Drug Administration in 2011 following trials at Yale-New Haven Hospital and four other medical centers. It is the first technology to deliver three-dimensional images in mammography, allowing radiologists to view the breast in detailed 1 mm sections. “We can characterize lesions better. You get a better view of the margins [the area at the edge of the tumor], which makes for a better assessment,” Philpotts says.

In 2013 Philpotts and colleagues reported online in the journal Radiology that the technology is most beneficial for patients aged 40 to 50 and those with dense tissue, but that it also has significant benefits for patients into their 70s.

Says Philpotts, “The bottom line is that every patient benefits.”