Performance of Digital Breast Tomosynthesis, Synthetic Mammography, and Digital Mammography in Breast Cancer Screening: A Systematic Review and Meta-Analysis

Author:

Alabousi Mostafa1,Wadera Akshay1,Kashif Al-Ghita Mohammed2,Kashef Al-Ghetaa Rayeh3,Salameh Jean-Paul4,Pozdnyakov Alex5,Zha Nanxi1,Samoilov Lucy1,Dehmoobad Sharifabadi Anahita1,Sadeghirad Behnam6,Freitas Vivianne7,McInnes Matthew DF8,Alabousi Abdullah9

Affiliation:

1. Department of Radiology, McMaster University, Hamilton, ON, Canada

2. Faculty of Biomedical Sciences, Western University, London, ON, Canada

3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

4. Department of Radiology, University of Ottawa, Ottawa, ON, Canada

5. Faculty of Medicine, McMaster University, Hamilton, ON, Canada

6. Department of Health Research Methods, Evidence, and Impact (HEI), The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada

7. Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada

8. Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada

9. Department of Radiology, McMaster University, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada

Abstract

Abstract Background Our objective was to perform a systematic review and meta-analysis comparing the breast cancer detection rate (CDR), invasive CDR, recall rate, and positive predictive value 1 (PPV1) of digital mammography (DM) alone, combined digital breast tomosynthesis (DBT) and DM, combined DBT and synthetic 2-dimensional mammography (S2D), and DBT alone. Methods MEDLINE and Embase were searched until April 2020 to identify comparative design studies reporting on patients undergoing routine breast cancer screening. Random effects model proportional meta-analyses estimated CDR, invasive CDR, recall rate, and PPV1. Meta-regression modeling was used to compare imaging modalities. All statistical tests were 2-sided. Results Forty-two studies reporting on 2 606 296 patients (13 003 breast cancer cases) were included. CDR was highest in combined DBT and DM (6.36 per 1000 screened, 95% confidence interval [CI] = 5.62 to 7.14, P < .001), and combined DBT and S2D (7.40 per 1000 screened, 95% CI = 6.49 to 8.37, P < .001) compared with DM alone (4.68 per 1000 screened, 95% CI = 4.28 to 5.11). Invasive CDR was highest in combined DBT and DM (4.53 per 1000 screened, 95% CI = 3.97 to 5.12, P = .003) and combined DBT and S2D (5.68 per 1000 screened, 95% CI = 4.43 to 7.09, P < .001) compared with DM alone (3.42 per 1000 screened, 95% CI = 3.02 to 3.83). Recall rate was lowest in combined DBT and S2D (42.3 per 1000 screened, 95% CI = 37.4 to 60.4, P<.001). PPV1 was highest in combined DBT and DM (10.0%, 95% CI = 8.0% to 12.0%, P = .004), and combined DBT and S2D (16.0%, 95% CI = 10.0% to 23.0%, P < .001), whereas no difference was detected for DBT alone (7.0%, 95% CI = 6.0% to 8.0%, P = .75) compared with DM alone (7.0%, 95.0% CI = 5.0% to 8.0%). Conclusions Our findings provide evidence on key performance metrics for DM, DBT alone, combined DBT and DM, and combined DBT and S2D, which may inform optimal application of these modalities for breast cancer screening.

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Oncology

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