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There have been four screening trials comparing full-field digital mammography (FFDM) and film-screen mammography (FSM).1 None of these trials showed a significant difference in the diagnostic accuracy between the two in the population as a whole. The latest trial was the ACRIN study (DMIST), which compared FFDM with FSM in 42,760 women.1 DMIST showed that FFDM had some increased sensitivity in heterogenously dense or extremely dense breasts (mainly for DCIS).
Awareness of the limitations of DMIST and the other three trials will allow more meaningful scrutiny of their results and conclusions. The various types of bias or limitations in scientific investigations have recently been comprehensively described.2 When a new test is evaluated, its efficacy is determined by comparing its performance to that of the accepted reference test. The Kodak Min-R 2000 Screen-Film System (Kodak Health Imaging Croup, Rochester, NY) was used exclusively in the first three trials and at the majority of the DMIST sites. However, since DMIST was conducted, there has been significant improvement in mammographie film-screen technology that now utilizes a double-emulsion film. The Kodak MIN-R EV Screen-Film System has replaced the MIN-R 2000 system as the company's premium system. This means that the new state-of-the-art film-screen technology, such as the Kodak MIN-R EV System, has become the new reference standard to which FFDM must be compared. The results of DMIST or any other comparison study are open to question if the reference standard is no longer valid.
Optimizing Film-Screen Mammography
The S.O.F.T. Paddle® is one of several recently developed products that can enhance the performance of FSM. A conventional compression paddle produces optimum compression of only the thick posterior portion of the breast. Several compression paddles have been developed that rotate as compression is applied. They tilt downward over the anterior breast but, at the same time, they rotate upward posteriorly. Unfortunately, this causes suboptimal compression of the posterior breast, which is where...