Tomosynthesis in breast screening: great expectations?
Mené en Norvège auprès de 28 749 participantes (âge : de 50 à 69 ans), cet essai évalue, du point de vue du taux de détection, l'efficacité d'une tomosynthèse mammaire numérique, incluant une mammographie synthétique 2D, par rapport à une mammographie numérique standard
Digital breast tomosynthesis, also known as three-dimensional mammography, has been under investigation as a replacement for or complement to two-dimensional (2D) digital mammography in breast cancer screening for some years, with several prospective, population-based trials reporting increased cancer detection. So far, published studies have been of paired design, in which each woman is her own control—ie, imaged with both digital mammography and digital breast tomosynthesis, read and reported in separate reading groups with either stand-alone digital breast tomosynthesis, or digital breast tomosynthesis in combination with digital mammography or so-called synthetic digital mammography in the digital tomosynthesis group. The paired study design is efficient when used to assess screening performance measures such as percentages of cancer detection and recall. Even if early screening performance measures indicate increased breast cancer detection with digital breast tomosynthesis, whether this design translates into lower proportions of interval cancer and improved long-term reduction in breast cancer mortality, compared with 2D mammography screening, should be elucidated. This assessment cannot be done in a paired study because all women undergo both techniques. Randomised controlled trials such as the To-Be trial 2
by Solveig Hofvind and colleagues, reported The Lancet Oncology, are therefore needed. Breast cancer mortality as an endpoint requires large numbers of women, multiple sites, and extended follow-up, and policy decisions are unlikely to wait a decade; therefore, a potential reduction in the proportions of interval cancer is an important surrogate measure.
The Lancet Oncology , commentaire, 2018