The edition · Radiology
Tomosynthesis trims interval breast cancers without reaching significance, and night-shift fatigue costs chest film accuracy
The TOSYMA trial reports interval cancer rates in nearly 99,000 screen-negative women, a reader study shows fatigued residents lose accuracy without slowing down, and a meta-analysis favours catheter drainage over needle aspiration for liver abscess.
The edition in brief
In the German TOSYMA trial, women aged 50 to 70 screened with digital breast tomosynthesis plus synthesised mammography had 14.2 invasive interval cancers per 10,000 negative screens over 24 months, against 18.6 with digital mammography (adjusted OR 0.76, 95% CI 0.55 to 1.06). The primary endpoint was not significant, though the 12-month secondary outcome was (OR 0.71). Together with the trial's higher detection rate, it supports tomosynthesis but does not settle it. In a reader study of ten radiology residents, six met an eye-tracking definition of fatigue after a night shift, and their chest radiograph accuracy fell (kappa 0.71 to 0.61) while reporting speed did not change; the AI tool tested did not restore accuracy. A meta-analysis of 12 randomised trials in 1,425 patients found percutaneous catheter drainage more successful than needle aspiration for liver abscess (OR 4.12) with similar complications. The pearl covers comparing with prior mammograms.
Night-shift fatigue lowers chest radiograph accuracy without slowing the reader
Treat post-night-shift reporting as higher risk, and consider second reads rather than relying on AI to make up the gap.
Catheter drainage beats needle aspiration for liver abscess
Consider percutaneous catheter drainage rather than needle aspiration as first-line image-guided treatment for liver abscess.
Pull the prior mammograms before you recall
Compare with prior mammograms before recalling, unless the finding is clearly suspicious.
Tomosynthesis screening: about a quarter fewer interval cancers, but not significant
Consider tomosynthesis plus synthesised mammography where it is available; it may reduce interval cancers, but the primary trial result was not significant.
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