Recommendation for NHSScotland
Digital breast tomosynthesis (DBT) can be used to aid diagnosis for women who have been recalled from initial breast screening for further assessment. Eight studies have compared DBT with supplementary mammographic views (SMVs, which is the current standard of care).
In six studies the diagnostic accuracy was comparable, and in two the diagnostic accuracy of DBT was superior. DBT takes an image of the whole breast. Coned mammographic views require careful positioning of the patient to avoid potential errors resulting from lesions being placed outside the field of compression. DBT would normally replace SMVs, and therefore would not result in an additional dose of radiation. It is not possible to comment on the cost effectiveness of DBT compared to SMV because no economic studies were identified.
DBT is already available but disabled on most of the mammography machines in screening centres within NHS Scotland. On balance, the Scottish Breast Screening Programme (SBSP) should consider enabling the DBT capability on the machines in screening centres in NHSScotland, for use in women who have been recalled from breast screening for further assessment.
NHSScotland is required to consider the Scottish Health Technologies Group (SHTG) advice.
What were we asked to look at?
In women who have been recalled from breast screening, what is the clinical and cost effectiveness of digital breast tomosynthesis (DBT) compared with coned views?
Why is this important?
This advice relates to replacing supplementary mammographic views (SMVs) with digital breast tomosynthesis (DBT). DBT is an advanced form of breast imaging. The purpose of this work was to establish the evidence base for the use of digital breast tomosynthesis (DBT), in place of coned views, in women recalled from breast screening for further assessment.
SBSP (Scottish Breast Screening Programme) Clinical Directors Group