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Recently Approved Screening Tool Offers 3-D View of Breast

Jason Merrill

Dione Farria, MD, MPH

Feb. 16, 2011 – A new technology approved by the U.S. Food and Drug Administration (FDA) on Feb. 11 – breast tomosynthesis – offers radiologists at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine 3-D images of breast tissue for screening mammography instead of traditional two-dimensional images alone.

Breast tomosynthesis is a special application of digital mammography that takes a series of 15 low-dose X-ray images at one time. When put together, the images allow radiologists to view the breast in three dimensions.

Radiologists at Siteman have used the technology in clinical studies since 2009.

“One of the advantages of breast tomosynthesis is that with 2-D imaging, the breast tissue overlaps quite a bit so you may often see false positives,” says Dione Farria, MD, a Washington University breast radiologist who practices at the Joanne Knight Breast Health Center at Siteman. “What you think are abnormalities are really just overlapping tissue from different planes.”

(Listen to Farria discuss breast tomosynthesis in a Cancer Connection podcast)

Abnormal findings in mammography lead to one in 10 women being called back for additional testing or procedures. A study in the August 2009 issue of the American Journal of Roentgenology found that breast tomosynthesis in combination with digital mammography helped reduce the recall rate by 30 percent.

That’s thought to be significant because women who come back for more screening undergo not only additional X-rays but also experience the anxiety of being called back.

“One of the potential advantages to tomosynthesis is reducing the number of women who have to come back,” says Farria, who is principal investigator of a breast tomosynthesis study at Siteman.

While breast tomosynthesis offers a radiologist enhanced images, the experience for a patient is no different than traditional mammography. At this point, the technology is not covered by most insurance companies because its role in the breast cancer screening process is still being studied.

“What we don’t know yet is if it should be used for all women who have a screening mammogram or if it should be used on a subset of women,” Farria says. “For example, women who have dense breasts or women who get their first mammogram. Because when you get your first mammogram, the likelihood of being called back is much greater.”