0:00

In terms of performance, we certainly know that by looking through

0:04

many tomosome slices, this increases our reading time compared to standard

0:08

2D demography, has a significant impact on operational workflows and

0:14

staffing. Multiple studies have demonstrated a reduction in recall rate

0:19

and increase in cancer detection rate for DBT compared to 2D alone. Screening

0:25

performance improvements are likely related to DBT ability to detect cancers

0:30

even when obscured by dense tissue and also differentiate true lesions from

0:35

tissue overlap. Best estimates of reducing recall rate is about 15%

0:40

and may increase our cancer detection rate or CDR by about 30%

0:43

and this is true even in patients with

0:47

lower breast density, suggesting that DBT improves cancer conspicuity. Of

0:54

course, people have started to use DBT in the diagnostic setting as well,

1:00

not just screening. And research has shown that this improves abnormal interpretation

1:06

rate, meaning that it decreases that. Increases PPV, both PPV2 and PPV3,

1:11

with a higher proportion of invasive cancers identified. DBT can replace

1:17

standard 2D diagnostic use for non calcified lesions. So your standard mass

1:21

or asymmetry with improved diagnostic accuracy. It also offers the potential

1:26

benefit of more efficient imaging with fewer views, potentially even without

1:31

additional diagnostic mammography and proceeding directly to ultrasound.

1:34

This last point is still, I'd say, talked about a little bit in

1:39

the literature about what is the best method and practices will make up

1:42

their own individual decision about how they feel about this. There are

1:45

some people that argue that screening DBT provides the same

1:50

amount of lesion localization, margin detection as doing additional views

1:58

and therefore the additional diagnostic mammogram views are not necessary

2:01

and you could go directly to ultrasound. There are other practices that

2:05

feel that doing those additional DBT views in the diagnostic setting do

2:10

still improve your ability to describe lesions and identify lesions.

2:15

And also prefer that for an operational reason,

2:20

meaning that it's easier to go ahead and do your mammogram first and

2:23

then ultrasound and you get the benefit of doing additional sort of non

2:28

standard views such as a medial lateral view or maybe an XCCL tomo view

2:33

or something like that to better help you identify or localize that lesion.

2:40

In terms of pathology outcomes, there's increased identification of architectural

2:43

distortion with DBT and these architectural distortions tend to be less

2:47

likely to be malignant compared to 2D, meaning that we probably see more

2:51

radial scars and complex sclerosing lesions, which depending on your practice,

2:54

either be considered benign or high risk, but it also improves diagnosis

2:58

of invasive breast cancers, which tend to be smaller,

3:02

lower grade in earlier stage and no negative. And we also see more

3:05

invasive lobular carcinomas largely due to the fact that they're probably

3:09

just more conspicuous on DBT as those are one of the most difficult

3:12

invasive cancers to identify on mammography.