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Digital mammography in a screening programme and its implications for pathology: a comparative study
  1. Linda Feeley1,
  2. Donal Kiernan2,
  3. Therese Mooney2,
  4. Fidelma Flanagan3,4,
  5. Gormlaith Hargaden3,4,
  6. Malcolm Kell4,5,
  7. Maurice Stokes4,5,
  8. Margaret Kennedy1,4
  1. 1Department of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland
  2. 2BreastCheck, King's Inn House, Dublin, Ireland
  3. 3Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
  4. 4Eccles Breast Screening Unit, Mater Misericordiae University Hospital, Dublin, Ireland
  5. 5Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
  1. Correspondence to Dr Linda Feeley, Department of Histopathology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland; lindafeeley{at}


Aims Most studies comparing full-field digital mammography (FFDM) with conventional screen-film mammography (SFM) have been radiology-based. The pathological implications of FFDM have received little attention in the literature, especially in the context of screening programmes. The primary objective of this retrospective study is to compare FFDM with SFM in a population-based screening programme with regard to a number of pathological parameters.

Methods During the study period, 107 818 women underwent screening mammograms with almost equal numbers obtained with each technique (49.9% with SFM vs 50.1% with FFDM). We compared SFM with FFDM using the following parameters: recall rate, diagnostic core biopsy rate, cancer detection rates, B3 rate, B4 rate, preoperative diagnostic rate for malignancy, positive predictive values and tumour characteristics.

Results The recall rate was significantly higher with FFDM (4.21% vs 3.52%, p<0.0001). The overall cancer detection rate of 7.2 per 1000 women screened with FFDM was also significantly higher than the rate of 6.2 per 1000 women screened with SFM (p=0.04). The B3 rate in the SFM group was 1.3 per 1000 women screened versus 2.5 per 1000 women screened in the FFDM group (p<0.001). The recall rate and cancer detection rates (overall, invasive and pure ductal carcinoma in situ) were all significantly higher with FFDM for lesions presenting as microcalcifications.

Conclusions The higher cancer detection rate with FFDM in this study was due to improved detection of microcalcifications. However, this was achieved at the cost of a higher recall rate and a higher B3 rate, indicating that overtreatment may be problematic with digital mammography.

  • Digital mammography
  • breast cancer screening
  • pathology
  • breast cancer
  • breast pathology

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  • Competing interests None.

  • Ethics approval Ethics approval was provided by Mater Misericordiae University Hospital's Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.