Breast

The incidence of missed breast cancers with the use of digital breast tomosynthesis in a symptomatic breast unit

Dr. Mun Wai Lam - Hywel Dda NHS Trust
Ali Moalla / Saira Khawaja / Anita Huws / Daniel Thomas / Asma Munir / Laura Mills / Yousef Sharaiha / Simon Holt
The incidence of missed breast cancers with the use of digital breast tomosynthesis in a symptomatic breast unit
Breast
Our aims were:
1. To determine the number of patients discharged from a symptomatic breast clinic who developed breast cancer within the next 2 years.
2. To determine how many cancers had been missed at initial assessment
In our institution, the majority of one stop breast clinics are conducted by surgeons who are qualified in performing ultrasounds of the breast and core biopsies if required. Our team also includes a breast physician and a breast radiologist who do their independent clinics for new patients. The breast radiologist double reads all mammograms.
The study period was between January 2015 to January 2017. All new patients referred to the breast unit during this time period were included. A total of 4680 new symptomatic patients were seen.
209 patients were diagnosed with breast cancer. Six patients presented previously to the breast unit within two years of diagnosis. Five out of six patients had dense breast tissue on DBT.
Our missed cancer rate was approximately 1 per 1000 patients. Our results of the triple assessment confirmed an accuracy rate of over 99%. The lowest sensitivity of initial assessment was in those with a breast density of Bi-Rads 4.
Our missed cancer rate is significantly lower than the reported incidence in the international literature. This is most likely because of the use of digital breast tomosynthesis in our unit for all patients undergoing mammograms. Our results conclude that surgeon led diagnostic breast clinics with second reading by a radiologist is safe and effective.
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