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Showing content from https://pubmed.ncbi.nlm.nih.gov/33372954/ below:

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

Meta-Analysis

. 2021 Jun 1;113(6):680-690. doi: 10.1093/jnci/djaa205. Performance of Digital Breast Tomosynthesis, Synthetic Mammography, and Digital Mammography in Breast Cancer Screening: A Systematic Review and Meta-Analysis Akshay Wadera¹, Mohammed Kashif Al-Ghita², Rayeh Kashef Al-Ghetaa³, Jean-Paul Salameh⁴, Alex Pozdnyakov⁵, Nanxi Zha¹, Lucy Samoilov¹, Anahita Dehmoobad Sharifabadi¹, Behnam Sadeghirad⁶, Vivianne Freitas⁷, Matthew Df McInnes⁸, Abdullah Alabousi⁹

Affiliations

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.

PMID: 33372954
PMCID: PMC8168096
DOI: 10.1093/jnci/djaa205

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Meta-Analysis

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

Mostafa Alabousi et al. J Natl Cancer Inst. 2021.

. 2021 Jun 1;113(6):680-690. doi: 10.1093/jnci/djaa205. Authors Mostafa Alabousi¹, Akshay Wadera¹, Mohammed Kashif Al-Ghita², Rayeh Kashef Al-Ghetaa³, Jean-Paul Salameh⁴, Alex Pozdnyakov⁵, Nanxi Zha¹, Lucy Samoilov¹, Anahita Dehmoobad Sharifabadi¹, Behnam Sadeghirad⁶, Vivianne Freitas⁷, Matthew Df McInnes⁸, Abdullah Alabousi⁹ Affiliations

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.

PMID: 33372954
PMCID: PMC8168096
DOI: 10.1093/jnci/djaa205

Item in Clipboard

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.

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Figures
Figure 1.

Study flow diagram. DBT =…

Figure 1.

Study flow diagram. DBT = digital breast tomosynthesis; DM = digital mammography; S2D…

Figure 1.

Study flow diagram. DBT = digital breast tomosynthesis; DM = digital mammography; S2D = synthetic 2D image.

Figure 2.

Forest plots and pooled estimates…

Figure 2.

Forest plots and pooled estimates of cancer detection rate (CDR). Results are shown…

Figure 2.

Forest plots and pooled estimates of cancer detection rate (CDR). Results are shown for (A) digital mammography (DM), (B) digital breast tomosynthesis (DBT) + DM, (C) DBT + synthetic 2-dimensional image (S2D), and (D) DBT. The dotted line represents the pooled summary estimate of the pooled CDR with the diamond illustrating the associated 95% confidence interval (CI). The squares represent the CDR for individual studies, with the solid lines associated with them representing the 95% confidence intervals. ES = effect size.

Figure 3.

Forest plots and pooled estimates…

Figure 3.

Forest plots and pooled estimates of invasive cancer detection rate (CDR). Results are…

Figure 3.

Forest plots and pooled estimates of invasive cancer detection rate (CDR). Results are shown for (A) digital mammography (DM), (B) digital breast tomosynthesis (DBT) + DM, (C) DBT + synthetic 2-dimensional image (S2D), and (D) DBT. The dotted line represents the pooled summary estimate of the pooled invasive CDR with the diamond illustrating the associated 95% confidence interval. The squares represent the invasive CDR for individual studies, with the solid lines associated with them representing the 95% confidence interval (CI). ES = effect size.

Figure 4.

Forest plots and pooled estimates…

Figure 4.

Forest plots and pooled estimates of recall rate. Results are shown for (…

Figure 4.

Forest plots and pooled estimates of recall rate. Results are shown for (A) digital mammography (DM), (B) digital breast tomosynthesis (DBT) + DM, (C) DBT + synthetic 2-dimensional image (S2D), and (D) DBT. The dotted line represents the pooled summary estimate of the pooled recall rate with the diamond illustrating the associated 95% confidence interval (CI). The squares represent the recall rate for individual studies, with the solid lines associated with them representing the 95% confidence interval (CI). ES = effect size.

Figure 5.

Forest plots and pooled estimates…

Figure 5.

Forest plots and pooled estimates of PPV1. Results are shown for ( A…

Figure 5.

Forest plots and pooled estimates of PPV1. Results are shown for (A) digital mammography (DM), (B) digital breast tomosynthesis (DBT) + DM, (C) DBT + synthetic 2-dimensional image (S2D), and (D) DBT. The dotted line represents the pooled summary estimate of the pooled positive predictive value (PPV1) with the diamond illustrating the associated 95% confidence interval. The squares represent the PPV1 for individual studies, with the solid lines associated with them representing the 95% confidence interval (CI). ES = effect size.