Breast cancer is the most frequently diagnosed cancer in women and is the second leading cause of cancer-related death. Mammography is recognized as the preferred methodology for detecting and evaluating patients with early stage breast cancer, however, it has a low positive predictive value. As a result, a high percentage of recalls for further imaging or biopsy do not yield higher rates of cancer detection. In fact, additional testing can place a substantial psychological and cost burden on patients and the healthcare system. By generating a 3-dimensional image of the breast tissue during standard mammographic compression, digital breast tomosynthesis (DBT) has been shown to reduce the noise from overlapping and superimposed breast tissue. In so doing, DBT has the potential to overcome the limits of mammography. Studies have shown that DBT is a highly cost-effective imaging technology in screening and diagnostic populations compared with full-field digital mammography, and as a result, advanced applications are now under investigation. Recent approvals of DBT by the US Food and Drug Administration and the Centers for Medicaid and Medicare Services for reimbursement have led to its increasing adoption by clinicians, and DBT also has found favor with women. The standard approaches to utilization and the most appropriate applications for clinical use are still being determined.
After reading this article, the participant should be able to:
- Describe the rationale for using digital breast tomosynthesis (DBT).(/li>
- Compare the different DBT modalities and their advantages/disadvantages.
- Evaluate the clinical evidence supporting the use of DBT in screening/diagnostic settings.
- Summarize the advanced applications of DBT.
- Assess the evidence demonstrating the cost effectiveness of DBT, support from the medical community, and how Medicare approval might affect access/reimbursement rates.