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Gus Iversen, Editor in Chief | July 14, 2025
A retrospective cohort study found that high-resolution digital breast tomosynthesis (DBT) is associated with a higher breast cancer detection rate compared to standard resolution DBT, particularly in women with previous screening history.
The study, published in
Clinical Imaging, analyzed 184,006 mammography exams conducted between 2013 and 2023 at Sanford Health, a U.S. health system headquartered in Sioux Falls, South Dakota. Of the total exams, 95,633 were performed using standard resolution (100-micron) and 88,373 with high resolution (70-micron) DBT systems.
Unadjusted cancer detection rates (CDR) were 5.38 per 1,000 screens for high-resolution and 4.87 for standard-resolution exams (p = 0.1296). However, after adjusting for potential confounders, including age, race, breast density, and radiologist, the odds of cancer detection were significantly higher with-high resolution imaging (OR = 1.370; 95% CI: 1.117–1.681).
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Recall rates (RR) were also slightly higher with high-resolution DBT at 9.80%, compared to 9.07% for standard resolution (p < 0.0001). The odds of recall remained elevated after adjustment (OR = 1.392; 95% CI: 1.327–1.460). The positive predictive value of recall (PPV1) showed no statistically significant difference between the two modalities: 5.57% for high resolution versus 5.45% for standard (p = 0.2730).
Among exams where patients had a known prior screen, the benefits of high-resolution imaging were more pronounced. Cancer detection increased to 5.38 per 1,000 for high-resolution exams, versus 4.22 for standard (p = 0.0020). In this subgroup, high-resolution imaging also yielded a higher PPV1 and lower recall rate when the previous exam was also high-resolution.
The analysis excluded exams performed during the transition to high resolution and required a minimum of six months follow-up for CDR and PPV1 metrics.
The study suggests that higher-resolution DBT systems may offer improved detection capabilities in real-world screening settings, especially for women undergoing routine follow-up imaging.
