When a suspicious lesion is detected in mammography screening, the woman is recalled for further assessment.

This recommendation evaluates whether digital breast tomosynthesis or additional mammographic projections should be used for the diagnosis of the lesion.

Healthcare question

Should digital breast tomosynthesis vs. diagnostic mammography projections be used in the assessment of recalled women of average risk of breast cancer due to suspicious lesions at mammography screening?


The ECIBC's Guidelines Development Group suggests using digital breast tomosynthesis (DBT) over diagnostic mammography projections in women at average risk for breast cancer recalled for suspicious lesions at mammography screening.

Recommendation strength ­

  Conditional recommendation for the intervention

  Moderate certainty of the test accuracy data

Subgroup considerations

The GDG agreed that this recommendation applies to both subgroups of patients examined, those with calcified lesions and those with non calcified lesions.

Monitoring and evaluation

Quality control procedures and quality standards should be further developed. Standards should be developed in particular for the image quality of synthesised 2D images from the tomosynthesis technology.

Research priorities

Ultrasound is often included in the management of assessment after a positive finding in screening mammography. Further research should be conducted exploring which subgroups would avoid ultrasound after DBT-additional projections, as well as which lesions (usually masses) are assessed with ultrasound instead of additional projections/DBT.

The use of DBT in high mammographic breast density should be explored, whether or not accuracy results are affected by breast density.

Whether or not to use one or two views for tomosynthesis in assessment should be explored.

Members of the GDG raised the question of whether the evidence discussed applies to repeated assessments too, but there was no agreement in the GDG if this is a research priority.

Supporting documents