BlueCross BlueShield of Tennessee Medical Policy Manual

Digital Breast Tomosynthesis (3D Mammogram)


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.   





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

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

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

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. Evidence Positioning System. (10:2016). Digital Breast Tomosynthesis (6.01.53). Retrieved October 5, 2018 from 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

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

U. S. Food and Drug Administration. (2011, February). 510(k) Premarket Notification Database. P080003. Retrieved July 14, 2011 from

U.S. Preventive Services Task Force. (2016). Breast cancer: screening. Retrieved March 1, 2016 from




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