High-Resolution Mammography Improves Breast Cancer Detection, Especially With Prior Imaging

New research suggests that high-resolution digital breast tomosynthesis (DBT) offers improved breast cancer detection over standard imaging methods, particularly when earlier mammograms are available for comparison.

DBT has already led to better detection, especially for women with dense breast tissue. But as imaging technology continues to evolve, recent enhancements have built upon DBT’s early success. In 2018, a higher-resolution system—boosting image clarity from a 100 μm to a 70 μm pixel size—was approved for clinical use. This high-resolution (HR) upgrade is believed to provide clearer tumor borders, subtler distortions, and better visibility of small micro-calcifications. Yet, little is known about how HR performs in clinical settings when compared to standard resolution (SR), especially regarding cancer detection, recall rates, and positive predictive value.

A recent study published in Clinical Imaging addresses this gap.

“With the introduction of any new breast screening technology, it is important to evaluate the impact on real world clinical outcomes,” said Melinda Talley, MD, a radiologist at Sanford Health in Sioux Falls, South Dakota, and lead author of the study.

To evaluate the effect of HR screening, Talley and colleagues analyzed over 180,000 mammograms conducted before and after HR technology became available. Their analysis focused on detection rates, recall rates, and positive predictive value, also considering how prior imaging influenced these outcomes.

Of the 184,006 mammograms studied, 95,633 were taken using SR, and 88,373 using HR. Positive predictive values were similar across both groups. Recall rates were slightly higher in the HR group, but researchers suggested this may be a short-term trend, common with newly introduced imaging methods.

“A transient increase in recall is consistent with previous advances in mammography,” the researchers explained. “For example, previous studies reported an increase in recall rates for women receiving their first digital mammogram, while the recall rates for women receiving subsequent digital mammograms was similar to the rates with film mammography.”

Cancer detection rates were higher with HR—5.38 per 1,000 exams versus 4.87 per 1,000 with SR. After adjusting for variables like age, race, breast density, risk profile, prior imaging resolution, facility, and interpreting radiologist, the difference was statistically significant. The advantage of HR imaging was even more pronounced when prior comparisons were available.

Although the increase in detection might appear modest, the researchers described it as “notable,” pointing out that earlier diagnosis often translates into better patient outcomes.