Digital breast tomosynthesis: sensitivity for cancer in younger symptomatic women

Patsy Whelehan, Kulsam Ali, Sarah Vinnicombe, Graham Ball, Julie Cox, Paul Farry, Maggie Jenkin, Keith Lowry, Stuart A McIntosh, Rachel Nutt, Rachel Oeppen, Michael Reilly, Michaela Stahnke, Jim Steel, Yee Ting Sim, Violet Warwick, Louise Wilkinson, Dimitrios Zafeiris, Andrew J Evans

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: Full-field digital mammography (FFDM) has limited sensitivity for cancer in younger women with denser breasts. Digital breast tomosynthesis (DBT) can reduce the risk of cancer being obscured by overlying tissue. The primary study aim was to compare the sensitivity of FFDM, DBT and FFDM-plus-DBT in women under 60 years old with clinical suspicion of breast cancer.

METHODS: This multicentre study recruited 446 patients from UK breast clinics. Participants underwent both standard FFDM and DBT. A blinded retrospective multireader study involving 12 readers and 300 mammograms (152 malignant and 148 benign cases) was conducted.

RESULTS: Sensitivity for cancer was 86.6% with FFDM [95% CI (85.2-88.0%)], 89.1% with DBT [95% CI (88.2-90%)], and 91.7% with FFDM+DBT [95% CI (90.7-92.6%)]. In the densest breasts, the maximum sensitivity increment with FFDM +DBT over FFDM alone was 10.3%, varying by density measurement method. Overall specificity was 81.4% with FFDM [95% CI (80.5-82.3%)], 84.6% with DBT [95% CI (83.9-85.3%)], and 79.6% with FFDM +DBT [95% CI (79.0-80.2%)]. No differences were detected in accuracy of tumour measurement in unifocal cases.

CONCLUSIONS: Where available, DBT merits first-line use in the under 60 age group in symptomatic breast clinics, particularly in women known to have very dense breasts.

ADVANCES IN KNOWLEDGE: This study is one of very few to address the accuracy of DBT in symptomatic rather than screening patients. It quantifies the diagnostic gains of DBT in direct comparison with standard digital mammography, supporting informed decisions on appropriate use of DBT in this population.

Original languageEnglish
Pages (from-to)20201105
JournalThe British Journal of Radiology
Issue number1119
Early online date7 Jan 2021
Publication statusPublished - 1 Mar 2021


  • Adult
  • Age Factors
  • Breast/diagnostic imaging
  • Breast Neoplasms/diagnostic imaging
  • Female
  • Humans
  • Mammography/methods
  • Middle Aged
  • Reproducibility of Results
  • Retrospective Studies
  • Sensitivity and Specificity
  • United Kingdom
  • Young Adult


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