Abstract
BackgroundThis study aimed to systematically review and to meta-analyse the accuracy of digital breast tomosynthesis (DBT) versus digital mammography (DM) in women with mammographically dense breasts in screening and diagnosis.MethodsTwo independent reviewers identified screening or diagnostic studies reporting at least one of four outcomes (cancer detection rate-CDR, recall rate, sensitivity and specificity) for DBT and DM in women with mammographically dense breasts. Study quality was assessed using QUADAS-2. Meta-analysis of CDR and recall rate used a random effects model. Summary ROC curve summarized sensitivity and specificity.ResultsSixteen studies were included (five diagnostic; eleven screening). In diagnosis, DBT increased sensitivity (84%–90%) versus DM alone (69%–86%) but not specificity. DBT improved CDR versus DM alone (RR: 1.16, 95% CI 1.02–1.31). In screening, DBT + DM increased CDR versus DM alone (RR: 1.33, 95% CI 1.20–1.47 for retrospective studies; RR: 1.52, 95% CI 1.08–2.11 for prospective studies). Recall rate was significantly reduced by DBT + DM in retrospective studies (RR: 0.72, 95% CI 0.64–0.80) but not in two prospective studies (RR: 1.12, 95% CI 0.76–1.63).ConclusionIn women with mammographically dense breasts, DBT+/−DM increased CDR significantly (versus DM) in screening and diagnosis. In diagnosis, DBT+/−DM increased sensitivity but not specificity. The effect of DBT + DM on recall rate in screening dense breasts varied between studies.
Highlights
This study aimed to systematically review and to meta-analyse the accuracy of digital breast tomosynthesis (DBT) versus digital mammography (DM) in women with mammographically dense breasts in screening and diagnosis
We found that in diagnostic studies, DBT with or without DM improved Cancer detection rate (CDR) (RR = 1.12, 95% CI 1.01–1. 24) and sensitivity compared to DM alone (84%–89% vs 69%–86%) in women with dense breasts, whereas specificity did not increase when DBT was used (72–93% vs 57–94%)
CDR was improved when using DBT with or without DM, in studies comparing within one study group (RR = 1.52, 95% CI 1.08– 2.12) or comparing two study groups of participants (RR = 1.33, 95% CI 1.20–1.47)
Summary
This study aimed to systematically review and to meta-analyse the accuracy of digital breast tomosynthesis (DBT) versus digital mammography (DM) in women with mammographically dense breasts in screening and diagnosis. Digital Breast Tomosynthesis (DBT) enables pseudo-3D imaging of the breast, resulting in better discrimination of tissue structures and potentially improved visualisation of cancer [10, 11]. DBT has the potential to improve both sensitivity and specificity of imaging in BC screening, leading to more detected cancers with fewer falsepositives [10]. Using both DM and DBT increases radiation dose to the breast, if both acquisitions
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