The browser you are using is not supported by this website. All versions of Internet Explorer are no longer supported, either by us or Microsoft (read more here: https://www.microsoft.com/en-us/microsoft-365/windows/end-of-ie-support).

Please use a modern browser to fully experience our website, such as the newest versions of Edge, Chrome, Firefox or Safari etc.

Portrait of Sophia Zackrisson. Photo

Sophia Zackrisson

Research group manager, Principal investigator, Professor, MD

Portrait of Sophia Zackrisson. Photo

Cancers not detected in one-view breast tomosynthesis screening—characteristics and reasons for non-detection

Author

  • Kristin Johnson
  • Debra M. Ikeda
  • Ingvar Andersson
  • Sophia Zackrisson

Summary, in English

Objectives: Limited understanding exists regarding non-detected cancers in digital breast tomosynthesis (DBT) screening. This study aims to classify non-detected cancers into true or false negatives, compare them with true positives, and analyze reasons for non-detection. Materials and methods: Conducted between 2010 and 2015, the prospective single-center Malmö Breast Tomosynthesis Screening Trial (MBTST) compared one-view DBT and two-view digital mammography (DM). Cancers not detected by DBT, i.e., interval cancers, those detected in the next screening round, and those only identified by DM, underwent a retrospective informed review by in total four breast radiologists. Reviewers classified cancers into true negative, false negative, or non-visible based on both DBT and DM findings and assessed radiographic appearances at screening and diagnosis, breast density, and reasons for non-detection. Statistics included the Pearson X2 test. Results: In total, 89 cancers were not detected with DBT in the MBTST; eight cancers were solely in the DM reading mode, 59 during subsequent DM screening rounds, and 22 interval cancers. The proportion of cancers classified as false negative was 25% (22/89) based on DBT, compared with 18% (14/81) based on DM screening. The primary reason for false negatives was normal-appearing density, 50% (11/22). False negatives exhibited lower rates of high breast density, 36% (8/22), compared with true positives, 61% (78/129), p = 0.04, and spiculated densities were less frequent in false negatives, 41% (9/22) compared with true positives, 68% (88/129), p = 0.01. Conclusion: False negatives in one-view DBT screening commonly presented with spiculated features, but less frequently than true positives, and were missed or misinterpreted due to benign appearances. Key Points: Question Cancers not detected in digital breast tomosynthesis screening, including false negatives, remain partly unexplored. Findings The most common reason behind false-negative cancers in a large screening trial was a normal-appearing density. Clinical relevance Recognizing the factors contributing to false negative findings in digital breast tomosynthesis screening is essential to further improve cancer detection.

Department/s

  • Radiology Diagnostics, Malmö
  • LUCC: Lund University Cancer Centre
  • EpiHealth: Epidemiology for Health
  • LTH Profile Area: Photon Science and Technology
  • LU Profile Area: Light and Materials

Publishing year

2024

Language

English

Publication/Series

European Radiology

Document type

Journal article

Publisher

Springer

Topic

  • Cancer and Oncology

Keywords

  • Adults
  • Breast
  • Mammography
  • Screening
  • Tomosynthesis

Status

Epub

Research group

  • Radiology Diagnostics, Malmö

ISBN/ISSN/Other

  • ISSN: 0938-7994