Positive Predictive Value of Mammography using Tomosynthesis: Analysis

This assignment delves into the positive predictive value (PPV) of mammography, specifically focusing on the impact of tomosynthesis. The analysis highlights that the addition of tomosynthesis increases the PPV of mammography, leading to a higher cancer detection rate and reduced false positives, which is crucial for early detection and treatment. The author would encourage family members to undergo tomosynthesis mammography due to its enhanced accuracy, especially for women with dense breast tissue. However, the author also acknowledges instances where tomosynthesis might not be the best choice, such as in advanced cancer stages or when urgent treatment is needed, and the higher radiation exposure compared to traditional mammography. The assignment also explores methods to increase PPV, such as improving the specificity and sensitivity of screening, and emphasizes the importance of considering the prevalence of breast cancer in the screened population. The assignment concludes with a discussion of the importance of early detection and the role of radiologists in interpreting images, highlighting the benefits of tomosynthesis over traditional mammography.

Positive predictive value
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Then please tell me what you think about the increase in positive predictive value of
mammography using tomosyntheses. Would you encourage a family member (or would
you yourself) to get mammography with tomosynthesis rather than traditional
mammography? Why or why not?
One of the reasons why addition of tomosynthesis in mammography increases positive predictive
value is that, there is increase in the rate of cancer detection using the system. From the analysis
provided in the article, positive predictive value moves from 4.4% when using digital
mammography to 6.6% when using tomosynthesis. When applying tomosynthesis acquiring
image from an x-ray source is very easy. Hooley et al, (2017) stated that the source of the image
moves over an arc during the process. The movement facilitate configuration of the images into
smaller slices hence reducing the impact of overlapping structure of the breast in women.
Women’s breast always have dense tissue, hence using digital mammography alone limits the
rate at which cancer can be detected, therefore the reduction in positive predictive value.
Personally, I would encourage family member to attend get mammography with tomosyntheiss
rather traditional mammography. I have multiple reasons to support my stand. Even though the
traditional mammography have done a critical role to reduce the breast cancer mortality rate,
there are many complaints from women who attend the screening. The first main criticism is
about inaccurate positive outcome. Consequently, using tomosynthesis there is hope for positive
results. The reason is that tomosynthesis make use of 3-D technology to reconstruct the breast
tissues according to Rafferty et al, (2017). In the process, the radiologist have a clear view of all
the breast tissues that might have overlapped according to Yi et al, (2019). Another important
benefit of family member or myself going to tomosynthesis mammography is that it promises
reduction in the rate of recall to all patients. It means that both women who have dense breast

tissues and those younger women can get positive result. Therefore, addition of tomosynthesis
simply increase the rate of detecting cancer and minimizes false positive outcome.
Are there any instances where you might not suggest tomosynthesis?
Tomosynthesis offers multiple benefits to cancer patients and therefore there are rare instances
where I cannot suggest tomosynthesis. However, there are only few instances where one might
use tomosynthesis. One of the instance is when the cancer have gone to later stages and it
requires keen interpretation of the images according to Mariscotti et al, (2017). After screening
using tomosynthesis, the interpretation of the images usually takes time. It means that if the
patient need urgent treatment, tomosynthesis might not offer urgent services. Apart from the
above instance, another situation is when the patient have other body illnesses. Tomosynthesis
always give out higher radiation than mammography and some of these radiations might injure
some body parts. Lastly, the capability of the patient to fund the screening determines the
suggestion. Tomosynthesis is always costly as compared to mammography. In some areas it is
always a challenge to find a facility that offers tomosynthesis screening.
On the other hand, the research letter also outlines some limitations of tomosynthesis. For
instances, the method collects data at the population level instead of the patient level. Besides
that, there is a minimal patient follow up. Lack of follow up decreases the outcome in women
with breast cancer. When the patient needs a close follow up the method is less important.
Despite few instances that makes this system challenging, there are a lot of benefits of using
tomosynthesis. For example, tomosynthesis facilitate checkup and screening of multiple layers of
the breast in a three dimension method. With this method, it outsmart the traditional
mammography. The radiologist is able to check the smaller lesions of the breast therefore
minimum false positive results. It even handles the dense breast and that makes it more accurate

than the traditional mammography. The most important concept is the capability to detect breast
cancer before a woman start showing the physical signs. It is an activity that doctors cannot do
and therefore they can begin couching the patient as early as possible. When cancer is detected
early, it can be easily be treated.
Explain one way in which the positive predictive value of this test could be increased.
Predictive in breast cancer screening refers to the probability of a patient having breast cancer.
When the value is positive then the patient might be having the cancer, however, negative value
implies that the patient is free from breast cancer. However, according to Murakami et al, (2020)
the main goal in every breast cancer screening is the capability of the machines to provide
accurate positive value. Consequently, one of the main ways of increasing positive predictive
value is improving the specificity and the sensitivity of breast cancer screening. The prevalence
of breast cancer in women that are undergoing breast cancer screening is important. When the
breast cancer screening is more sensitive, it will be rare for a woman who do not have the cancer
to test positive. It is the same way when the screening is more specific, it will be rare for a
woman with breast cancer to test negative. Therefore, positive predictive value will be enhanced.
On the other hand, it is important to note that prevalence of the cancer is important in every
screening, according to Reese et al, (2017) when the prevalence of the breast cancer in women is
low, then positive predictive also reduces. In such circumstances, using machines that are
specific and sensitive may not change the outcomes. When further diagnosis us done to women
who might have registered positive results, the outcome may be that they do not have the cancer.
It is important to choose women who are at high risk of getting breast cancer to increase positive
predictive value. Breast cancer is among the killer diseases in women and therefore proper
screening is important. There are cases where two radiologist can have two different positive

predictive value. Such occasion raises questions on the sensitivity and the specialty of the
screening process.

References
Hooley, R. J., Durand, M. A., & Philpotts, L. E. (2017). Advances in digital breast
tomosynthesis. American Journal of Roentgenology, 208(2), 256-266.
Mariscotti, G., Durando, M., Houssami, N., Fasciano, M., Tagliafico, A., Bosco, D., ... &
Gandini, G. (2017). Comparison of synthetic mammography, reconstructed from digital
breast tomosynthesis, and digital mammography: evaluation of lesion conspicuity and BI-
RADS assessment categories. Breast cancer research and treatment, 166(3), 765-773.
Murakami, R., Uchiyama, N., Tani, H., Yoshida, T., & Kumita, S. (2020). Comparative analysis
between synthetic mammography reconstructed from digital breast tomosynthesis and
full-field digital mammography for breast cancer detection and visibility. European
Journal of Radiology Open, 7, 100207.
Rafferty, E. A., Rose, S. L., Miller, D. P., Durand, M. A., Conant, E. F., Copit, D. S., ... &
Carlson, K. L. (2017). Effect of age on breast cancer screening using tomosynthesis in
combination with digital mammography. Breast cancer research and treatment, 164(3),
659-666.
Reese, D. E., Henderson, M. C., Silver, M., Mulpuri, R., Letsios, E., Tran, Q., & Wolf, J. K.
(2017). Breast density does not impact the ability of Videssa® Breast to detect breast
cancer in women under age 50. PloS one, 12(10).
Research letter file:///E:/mike/4014337_871168983_RESEARCHLETTERFORFORUMPOST.pdf
Yi, A., Chang, J. M., Shin, S. U., Chu, A. J., Cho, N., Noh, D. Y., & Moon, W. K. (2019).
Detection of noncalcified breast cancer in patients with extremely dense breasts using

digital breast tomosynthesis compared with full-field digital mammography. The British
journal of radiology, 92(1093), 20180101.