Detecting Infiltrating Breast Ductal Carcinoma: Tomosynthesis in High Risk Patients Interview with:
Sarah H. O’Connell M.D.
Yale New Haven Hospital
Yale School of Medicine Department of Diagnostic Radiology  What are the main findings of the study?

Answer: The purpose of our study was to evaluate the visibility of cancers in women at high-risk for breast cancer on 2D mammography compared to digital breast tomosynthesis.

In other words, how would the use of tomosynthesis contribute to cancer visualization in this population  of patients?

We evaluated the cancers seen in both high-risk patients, those with a >20% lifetime risk of breast cancer, and intermediate risk  patients, those with a 15-20% lifetime risk of breast cancer, for a total of 56 cancers.

We found that 41% (23/56) cancers were better seen on tomosynthesis and 4% (2/56) were only seen on tomosynthesis. The majority of the cancers seen better or only on tomosynthesis  presented as masses rather than as calcifications alone which were better seen on 2D mammography.  Were any of the findings unexpected?

Answer: No, our findings are consistent with what others have found regarding cancer visualization on tomosynthesis vs. 2D mammography.

Tomosynthesis gives us the capability to scroll through the breast tissue in 1 mm sections, which allows us to see finer detail and detect additional cancers. In our study, cancers that presented as clustered calcifications were best appreciated on 2D mammography, since the entire cluster of calcifications was not typically contained within a single plane of a tomosynthesis view. However, the morphology of individual calcifications was often better defined with tomosynthesis and further work is being done on optimal visualization of calcifications with tomosynthesis. What should clinicians and patients take away from your report?

Answer:  Our study showed that in this select group of women, the addition of tomosynthesis to 2D mammography was helpful in visualizing cancers. The combination of tomosynthesis with 2D mammography is emerging as a useful modality in women at all risk levels, and its benefits may be particularly relevant to women at high risk of breast cancer, in whom it’s especially important to reduce the anxiety associated with false positive screening mammograms as well as to improve early detection of biologically aggressive cancers.  What recommendations do you have for future research as a result of this study?

Answer: Further work is being done to optimize visualization of calcifications with tomosynthesis which will be very valuable.

Additionally, studies to evaluate the potential contribution of  tomosynthesis in detecting cancers in women with dense breasts would be very useful.


Tomosynthesis improves detection of infiltrating ductal carcinoma in patients with increased risk.

Presented at ARRS Annual Meeting in Washington, DC 2013

Last Updated on November 3, 2014 by Marie Benz MD FAAD