European guidelines on breast cancer screening and diagnosis

Should digital breast tomosynthesis vs. assessment mammography be used to diagnose breast cancer in recalled women due to suspicious lesions at mammography screening?

It is a conditional recommendation mainly due to the availability of the devices. In addition, despite moderate certainty in the high accuracy of the test results, and a balance that probably favours DBT, there are concerns about the associated moderate costs, increased training needed to correctly use this technology, absence of cost-effectiveness data and feasibility of its implementation.

The GDG agreed that this recommendation applies to both subgroups of patients examined, those with calcified lesions and those with non calcified lesions.

Quality control procedures and quality standards should be further developed. Standards should be developed in particular for the image quality of synthesised 2D images from the tomosynthesis technology.

• Ultrasound is often included in the management of assessment after a positive finding in screening mammography. Further research should be conducted exploring which subgroups would avoid ultrasound after DBT-additional projections, as well as which lesions (usually masses) are assessed with ultrasound instead of additional projections/DBT.
• The use of DBT in high mammographic breast density should be explored, that is, whether or not accuracy results are affected by breast density.
• Members of the GDG raised the question of whether the evidence discussed applies to repeated assessments too, but there was no agreement in the GDG if this is a research priority.
• Whether or not to use one or two views for tomosynthesis in assessment should be explored.