3-D Mammography for Breast Cancer Detection

January 1, 2015

Technology offers improved detection, reduced call-back rate 

Innovations in Cancer - Winter 2015 - View Full PDF


Director, Breast Cancer Imaging, UH Seidman Cancer Center, Associate Professor of Radiology, Case Western Reserve University School of Medicine

University Hospitals Case Medical Center recently took part in a large multicenter trial comparing tomosynthesis (3-D mammography) with traditional mammography for the detection of breast cancer. Thirteen academic and non-academic centers from across the country participated, evaluating nearly one-half million breast examinations (approximately 281,000 by digital mammography and 174,000 by digital mammography plus tomosynthesis).

Results were recently published in the Journal of the American Medical Association. The bottom line: With the addition of tomosynthesis, our detection of breast cancers improved substantially, while our recall rate decreased.


Left, image of the breast using 2-D digital mammography. Right, image of the same breast using 3-D mammography clearly shows the more invasive cancer.

We were able to show a 41 percent relative increase in the invasive cancer detection rate for combined tomosynthesis and digital mammography, compared with digital mammography alone. We concluded that tomosynthesis is a much better examination for finding cancers that may otherwise hide within normal breast tissue on a regular mammogram. This makes sense because 3-D mammography provides many more images, each sliced at one-millimeter intervals throughout the breast. Instead of looking at four views from a regular mammogram in a woman with average-size breasts, for example, I may be looking at 200 images with tomosynthesis.


In addition to missing too many cancers in patients, traditional mammography has often been criticized for producing a large number of false positives. If we see something slightly suspicious or irregular on a mammogram, we call a woman back for additional imaging, which causes anxiety and extra cost to that patient.

In this study, we saw a 15 percent relative decrease in these call-backs using tomosynthesis, compared with 2-D digital mammography alone.

We looked further to determine how often we would find a cancer in the women called back. The relative increase in the positive predictive rate was 49 percent after tomosynthesis, compared with traditional mammography - an impressive jump. We also wanted to know whether the use of tomosynthesis affected the positive predictive value of a biopsy.

We found a relative increase of 21 percent. We are planning additional investigations of the large database from this study, including whether certain subpopulations separated by age and/or breast density benefit more from tomosynthesis than do others.


The bottom line of this study: Adding tomosynthesis to traditional mammography is a game-changing technology that makes us much better at what we do.

At our University Hospitals-affiliated mammography sites, we have a mixture of locations with traditional plus 3-D mammography (hybrid sites) or traditional mammography only. Patients at the hybrid sites are offered the choice of tomosynthesis in addition to traditional mammography, but they may have to check with their private insurers to determine whether they will be required to pay an additional out- of-pocket cost or deductible.

The Centers for Medicare and Medicaid Services (CMS) plans to implement the new CPT code and a reimbursement fee for tomosynthesis sometime in 2015. Earlier studies of the technology were much smaller, single-site investigations. We hope that this larger, more powerful multicenter trial may help drive approval for reimbursement for tomosynthesis by private insurers as well.

For more information about this study, see the article in JAMA 2014;311(24):2499-2507, or contact me at Donna.Plecha@UHhospitals.org.

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