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

Johnson, Kristin LU orcid ; Ikeda, Debra M. ; Andersson, Ingvar LU and Zackrisson, Sophia LU (2024) In European Radiology 35(7). p.3951-3960
Abstract

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,... (More)

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.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adults, Breast, Mammography, Screening, Tomosynthesis
in
European Radiology
volume
35
issue
7
pages
10 pages
publisher
Springer Science and Business Media B.V.
external identifiers
  • pmid:39706921
  • scopus:85212688917
ISSN
0938-7994
DOI
10.1007/s00330-024-11278-2
language
English
LU publication?
yes
id
ad207964-abfa-4df7-88ee-9d4259489ce6
date added to LUP
2025-01-28 12:57:55
date last changed
2025-07-02 01:37:46
@article{ad207964-abfa-4df7-88ee-9d4259489ce6,
  abstract     = {{<p>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 X<sup>2</sup> 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.</p>}},
  author       = {{Johnson, Kristin and Ikeda, Debra M. and Andersson, Ingvar and Zackrisson, Sophia}},
  issn         = {{0938-7994}},
  keywords     = {{Adults; Breast; Mammography; Screening; Tomosynthesis}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{3951--3960}},
  publisher    = {{Springer Science and Business Media B.V.}},
  series       = {{European Radiology}},
  title        = {{Cancers not detected in one-view breast tomosynthesis screening—characteristics and reasons for non-detection}},
  url          = {{http://dx.doi.org/10.1007/s00330-024-11278-2}},
  doi          = {{10.1007/s00330-024-11278-2}},
  volume       = {{35}},
  year         = {{2024}},
}