The ACR suggests that MRI should be considered in the following categories: in women with personal histories of breast cancer and who do not fit the 2 previously stated categories as well as in women with atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ [43]. FDG-PET Breast Dedicated There is limited relevant literature regarding the use of FDG-PET breast dedicated for supplemental screening in intermediate-risk women with dense breasts. This is not currently widely used in clinical practice. Supplemental Screening Based on Breast Density Sestamibi MBI There is limited relevant literature regarding the use of Tc-99m sestamibi MBI for supplemental screening in intermediate-risk women with dense breasts. This is not currently widely used in clinical practice. The greatest improvement in the CDR with DBT is seen in women with dense breast tissue [21,22,57,58]. Although the TOMMY trial did not reach statistical significance across all breast densities, in women with >50% breast density, statistical significance was achieved, with the sensitivity of 2-D mammography plus DBT reaching 93% versus 86% for 2-D mammography alone [21,22]. In a meta-analysis of 16 studies evaluating women with dense breasts, DBT improved the CDR compared with 2-D mammography alone in both the diagnostic (RR: 1.16) and the screening (RR: 1.33) settings [58]. In addition to the increase in the CDR, another benefit of adding DBT to 2-D mammography is the reduction in the recall rate [16-19]. In a single-center screening program, Sharpe et al [18] reported a reduction in the recall rate by 18.8%. In the prospective Oslo Tomosynthesis Screening Trial, the recall rate was reduced from 6.7/1,000 to 3.6/1,000 [19]. There is also evidence that the reduction in the recall rate is maintained over consecutive screening episodes [18].
Supplemental Breast Cancer Screening Based on Breast Density. The ACR suggests that MRI should be considered in the following categories: in women with personal histories of breast cancer and who do not fit the 2 previously stated categories as well as in women with atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ [43]. FDG-PET Breast Dedicated There is limited relevant literature regarding the use of FDG-PET breast dedicated for supplemental screening in intermediate-risk women with dense breasts. This is not currently widely used in clinical practice. Supplemental Screening Based on Breast Density Sestamibi MBI There is limited relevant literature regarding the use of Tc-99m sestamibi MBI for supplemental screening in intermediate-risk women with dense breasts. This is not currently widely used in clinical practice. The greatest improvement in the CDR with DBT is seen in women with dense breast tissue [21,22,57,58]. Although the TOMMY trial did not reach statistical significance across all breast densities, in women with >50% breast density, statistical significance was achieved, with the sensitivity of 2-D mammography plus DBT reaching 93% versus 86% for 2-D mammography alone [21,22]. In a meta-analysis of 16 studies evaluating women with dense breasts, DBT improved the CDR compared with 2-D mammography alone in both the diagnostic (RR: 1.16) and the screening (RR: 1.33) settings [58]. In addition to the increase in the CDR, another benefit of adding DBT to 2-D mammography is the reduction in the recall rate [16-19]. In a single-center screening program, Sharpe et al [18] reported a reduction in the recall rate by 18.8%. In the prospective Oslo Tomosynthesis Screening Trial, the recall rate was reduced from 6.7/1,000 to 3.6/1,000 [19]. There is also evidence that the reduction in the recall rate is maintained over consecutive screening episodes [18].