![\"Illustration](\"https:\/\/rtmedical.com.br\/wp-content\/uploads\/2026\/07\/us_dbt_candidate.jpg\")
Why tomosynthesis changed the math<\/h2>\n
Conventional 2D mammography compresses the entire thickness of the breast into a single projection. In dense breasts, overlapping fibroglandular tissue can both mask real tumors and mimic suspicious lesions. Tomosynthesis acquires a series of low-dose projections along an arc and reconstructs the breast in thin slices, giving radiologists a quasi-3D view that largely eliminates tissue overlap. The payoff is well documented: higher detection of invasive cancers and fewer recalls.<\/p>\n
That improvement is precisely what hollowed out ultrasound’s supplemental role. Many of the cancers that 2D mammography used to miss \u2014 the ones ultrasound was recruited to catch \u2014 are now picked up by tomosynthesis itself. What remains for ultrasound is an ever-smaller pool of occult cancers, while its well-known tendency to flag benign findings as suspicious has not changed. The result is a screening layer that generates plenty of anxiety, workups and expense, but very little added diagnosis.<\/p>\n
Breast MRI and contrast-enhanced mammography as alternatives<\/h2>\n
For women who genuinely need supplemental screening \u2014 those with extremely dense breasts or elevated risk \u2014 the authors recommend modalities with demonstrably higher sensitivity. Breast MRI remains the reference standard, and recent evidence shows breast MRI outperforming mammography in dense breasts<\/a> by a wide margin. Abbreviated MRI protocols, which cut scanner time to a few minutes, are making the exam increasingly feasible at screening scale.<\/p>\n Contrast-enhanced mammography (CEM) is the other contender: it uses iodinated contrast to reveal tumor enhancement, approaching MRI-level performance at lower cost and on adapted mammography equipment already present in most departments. Either option, the researchers argue, delivers the real diagnostic gain that ultrasound can no longer offer in a DBT-based program.<\/p>\n The practical implications are significant. In the United States, nationwide dense-breast notification rules have been in force since 2024, prompting millions of women to ask about supplemental screening. If ultrasound is the default answer, the study suggests, programs will accumulate biopsies, costs and patient anxiety with minimal cancer yield. Redirecting that demand toward MRI or CEM \u2014 guided by individual risk \u2014 looks like the more rational path.<\/p>\n Risk stratification itself is becoming smarter. Artificial intelligence models can now estimate a woman’s future breast cancer risk from the mammogram alone, as shown by work on AI mapping how breast cancer risk evolves over time<\/a>. Tools of this kind could help decide who truly benefits from supplemental imaging \u2014 and with which modality \u2014 rather than applying ultrasound indiscriminately to every dense breast.<\/p>\n The study has caveats the authors acknowledge. It is a single-center cohort with its own patient mix, equipment and reader expertise, and ultrasound performance is famously operator-dependent. Multicenter data and formal cost-effectiveness analyses are still needed before supplemental ultrasound is written off everywhere. In health systems where tomosynthesis has not yet replaced 2D mammography, the older evidence base \u2014 and ultrasound’s low cost and wide availability \u2014 still argue for keeping it in the toolkit.<\/p>\n Where DBT is the standard of care, however, the direction of travel seems clear: risk-adapted screening pathways in which abbreviated MRI and CEM absorb the supplemental role, with AI helping to target them. If other centers replicate these findings, screening ultrasound after negative tomosynthesis may soon be remembered as a transitional practice from the 2D era.<\/p>\nWhat it means for screening practice<\/h2>\n
Limitations and outlook<\/h2>\n