Clinical Scorecard: Evaluating False-Positive Recall Rates in the Malmö Breast Tomosynthesis Screening Study

At a Glance

Key Highlights

• False-positive recalls are common in breast cancer screening and can cause psychosocial distress and reduced re-attendance.
• The Malmö Breast Tomosynthesis Screening Trial (MBTST) compared one-view DBT with two-view DM in a prospective, population-based setting.
• False-positive recall rates and radiographic appearances differ between DBT and DM, with DBT showing a higher rate initially due to stellate distortions but a learning curve over time.

Guideline-Based Recommendations

Diagnosis

• Use both DBT and DM independently read by experienced radiologists to identify suspicious findings.
• Classify false-positive findings by radiographic appearance including stellate distortion, circumscribed mass, indistinct density, architectural distortion, focal asymmetry, and calcifications.
• Confirm breast cancer diagnosis through cross-linkage with cancer registries and biopsy results.

Management

• Recalled women undergo further imaging (DM, ultrasound) and, if indicated, fine needle aspiration or core needle biopsy.
• Work-up protocols should include multidisciplinary consensus review for unclear imaging findings.
• Surgical procedures reserved for cases requiring open biopsy or breast-conserving surgery.

Monitoring & Follow-up

• Track work-up time from screening to cancer exclusion, including all imaging and clinical visits.
• Follow women until next scheduled screening (18 to 24 months) to monitor outcomes and re-attendance.
• Monitor false-positive recall rates over time to assess learning curve effects.

Risks

• False-positive recalls may cause psychosocial distress and reduce future screening attendance.
• Higher false-positive recall rates with DBT initially, especially due to stellate distortions, may lead to increased biopsies and interventions.
• Risk of breast cancer is higher in women after a false-positive mammography screening compared to true negatives.

Patient & Prescribing Data

Women aged 40 to 74 years participating in breast cancer screening in Malmö, Sweden

One-view DBT screening may initially yield higher false-positive recalls than two-view DM, but rates decrease over time indicating a learning curve; combined imaging and biopsy protocols are essential for accurate diagnosis.

Clinical Best Practices

• Implement independent double reading of DBT and DM images by experienced breast radiologists.
• Categorize false-positive findings by detailed radiographic appearance to guide work-up.
• Use multidisciplinary consensus panels for ambiguous imaging findings to reduce unnecessary recalls.
• Adopt standardized work-up protocols including imaging and biopsy to confirm benign outcomes.
• Monitor false-positive recall rates longitudinally to optimize screening performance and reduce patient distress.

References

• Malmö Breast Tomosynthesis Screening Trial (MBTST) ClinicalTrials.gov