Reply to Letter to the Editor re: Diagnostic accuracy of digital breast tomosynthesis versus digital mammography for benign and malignant lesions in breasts: a meta-analysis

Abstract

Dear Editor, We were very pleased to receive your letter and appreciate the opportunity to respond to the concern raised about our article [1]. One of our criteria for pooling the data was that digital breast tomosynthesis (DBT) and digital mammography (DM) were used as the reference for diagnosing breast lesions. However, we placed no limitation on whether DBT was performed in one-view or two-view mode; so in agreement with the aforementioned letter, Michell et al. [2], Teerstra et al. [3] and Gur et al. [4] comparedDBT in two views versus DM. The other four studies [5–8] compared DBT in one view versus DM.We did not present this information in our article because the studies satisfied the criterion mentioned above, i.e. they were characterised as using DBT. Moreover, the heterogeneity analysis which we investigated as a possible factor in the oneview or two-view mode in the meta-regression analysis failed to provide any evidence of heterogeneity. Our prime objective was to evaluate the diagnostic performance of DBT and DM for benign and malignant lesions in breasts. Wementioned that “the present study usedmeta-analysis to evaluate whether there was a higher diagnostic accuracy of one-view DBTand two-view DM relative to the gold standard in breast lesions in the discussion part”. Table 1 shows the sensitivity and specificity of one-view or two-view DBT vs gold standard. We appreciate that the sensitivity and specificity of two-view DBT are higher than those of one-view DBT, but in consideration of certain factors, including cost, radiation dose, and discomfort for patients [9–11], we still maintain the conclusion that one-view DBT has a high sensitivity and specificity for the diagnosis of benign and malignant lesions in breasts [9]. Again, we would like to thank European Radiology for publishing our original article and the opportunity to clarify the diagnostic accuracy of DBT versus DM for benign and malignant breast lesions.