BlueCross BlueShield of Tennessee Medical Policy Manual

Digital Breast Tomosynthesis (3D Mammogram)

DESCRIPTION

Digital breast tomosynthesis, also referred to as three-dimensional (3D) mammography, creates a three-dimensional picture of the breast from many angles using low-dose x-rays.  The breast is positioned in a similar fashion to a conventional mammogram, with slightly less compression, while a scanner rotates around the breast in an arc formation.  Several images are taken over approximately seven seconds.  Once the images are taken, computer programs produce clear and highly-focused 3D representations of the breast that the radiologist can then view as thin layers of breast tissue, similar to CT scan images.  This technology allows for greater accuracy and easier identification of abnormalities.    

POLICY

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

SOURCES

American College of Obstetricians and Gynecologists. (2011, reaffirmed 2014). Practice Bulletin #122. Breast cancer screening. Retrieved September 21, 2016 from https://www.acog.org.

American College of Obstetricians and Gynecologists. (2015, March). Committee Opinion #625. Mamagement of women with dense breasts diagnosed by mammography. Retrieved September 19, 2017 from https://www.acog.org.

American College of Radiology. (2014). ACR statement on breast tomosynthesis. Retrieved August 24, 2016 from www.acr.org.

Bernardi, D., Macaskill, P., Pellegrini, M., Valentini, M., Fantὀ, C., Ostillio, L., et al. (2016). Breast cancer screening with tomosynthesis (3D mammography) with acquired or synthetic 2D mammography compared with 2D mammography alone (STORM-2): a population-based prospective study. Lancet Oncology, 17 (8), 1105-1113. Abstract retrieved August 25, 2016 from PubMed database.

BlueCross BlueShield Association. Medical Policy Reference Manual. (10:2016). Digital Breast Tomosynthesis (6.01.53). Retrieved September 19, 2017 from BlueWeb. (65 articles and/or guidelines reviewed)

ECRI Institute. Emerging Technology Evidence Report. (2016, September) Digital Breast Tomosynthesis for Breast Cancer Screening. Retrieved September 19, 2017 from ECRI Institute. (136 articles and/or guidelines reviewed)

Hodgson, R., Heywang-Kobrunner, Harvey, S.,  Edwards, E.,  Shaikh, J.,  Arber, M., et al. (2016) Systematic review of 3D mammography for breast cancer screening. The Breast, (27), 52-61. (Level 2 evidence)

McDonald, E., Oustimov, A., Weinstein, S., Synnestvedt, M., Schnall, M., & Conant, E. (2016). Effectiveness of digital breast tomosynthesis compared with digital mammography: outcomes analysis from 3 years of breast cancer screening. The Journal of the American Medical Association Oncology, 2 (6), 737-743. Abstract retrieved August 26, 2016 from PubMed database.

Melnikow, J., Fenton, J.J., Miglioretti, D., Whitlock, E.P., Weyrich, M.S. (2016). Screening for breast cancer with digital breast tomosynthesis. Evidence Synthesis No. 125. AHRQ Publication No. 14-05201-EF-2. Rockville, MD: Agency for Healthcare Research and Quality; 2016.  Retrieved August 24, 2016 from  http://www.ncbi.nlm.nih.gov.

National Comprehensive Cancer Network. (2017, June). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines™). Breast Cancer Screening and Diagnosis (V.1.2017). Retrieved September 19, 2017 from http://www.nccn.org.

Nelson, H., Cantor, A., Humphrey, L., Fu, R., Pappas, M., Daeges, M., & Griffin, J. (2016). Screening for breast cancer: a systematic review to update the 2009 U.S. Preventive Services Task Force recommendation. [Internet]. Retrieved March 1, 2016 from PubMed database.

Technology Evaluation Center. (2014, January). Use of digital breast tomosynthesis with mammography for breast cancer screening or diagnosis. (Vol. 28, No. 6). Retrieved July 8, 2015 from http://www.bcbs.com. (43 articles and/or guidelines reviewed)

U. S. Food and Drug Administration. (2011, February). 510(k) Premarket Notification Database. P080003. Retrieved July 14, 2011 from http://www.accessdata.fda.gov.

U.S. Preventive Services Task Force. (2016). Breast cancer: screening. Retrieved March 1, 2016 from http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening.

Winifred S. Hayes, Inc. Medical Technology Directory. (2015, September; last updated search August 2017).  Digital breast tomosynthesis for breast cancer diagnosis and screening. Retrieved September 19, 2017 from www.Hayesinc.com/subscribers. (68 articles and/or guidelines reviewed)

ORIGINAL EFFECTIVE DATE:  12/10/2011

MOST RECENT REVIEW DATE:  11/9/2017

ID_BT

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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