Comparing recall rates following implementation of digital breast tomosynthesis to synthetic 2D images and digital mammography on women with breast-conserving surgery

Objectives: To evaluate the recall rates of digital mammography (DM) and synthetic images after adding digital breast tomosynthesis (DBT) in patients with breast-conserving surgery. Methods: From November 2015 to April 2017, 229 women with breast-conserving surgery due to breast cancer who underwent DBT after surgery were included (mean interval, 12.9 ± 1.4 months). All women underwent combo-mode DBT examinations including full-field DM, tomosynthesis, and reconstructed synthetic 2D images. Three board-certified breast radiologists reviewed the images sequentially: synthetic 2D+DBT and, 1 month later, DM and then DM+DBT. Recall rates and the abnormality type causing the recall were calculated and compared for each mammographic modality and breast density. Results: Of the 229 patients included, 230 mammography images were reviewed. One patient (0.4%) developed locoregional recurrences during follow-up (mean duration, 25.8 ± 4.5 months). Recall rates for synthetic 2D+DBT were significantly lower than for DM alone (4.1% (2.6–6.2) vs. 11.6% (9.2–14.5), respectively; p < 0.001). Recall rates did not differ between synthetic 2D+DBT and DM+DBT (4.1% (2.6–6.2) vs. 2.9% (1.9–4.5), respectively; p = 0.234). Recall rates of synthetic 2D+DBT and DM+DBT were significantly lower than those of DM alone, regardless of mammographic breast density (all p < 0.05, respectively). Conclusion: Adding DBT to synthetic 2D images or DM shows significant reduction in recall rates compared with DM alone for women who undergo breast-conserving surgery for breast cancer, regardless of mammographic density. Key Points: • Recall rates for synthetic 2D+DBT were significantly lower than those of DM alone (4.1% (2.6–6.2) vs. 11.6% (9.2–14.5), respectively; p < 0.001). • No significant differences were seen in recall rates between synthetic 2D+DBT and DM+DBT (4.1 (2.6–6.2) vs. 2.9 (1.9–4.5), respectively; p = 0.234). • Reader-averaged recall rates after adding DBT to synthetic 2D or DM were significantly lower than those of DM alone, regardless of mammographic breast density (all p < 0.05, respectively).