Abstract
Background
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 breast tomosynthesis (DBT), combined DBT and digital mammography (DM), combined DBT and synthetic 2 D-mammography (S2D), and DM 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 utilized to compare imaging modalities. All statistical tests were two-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 1,000 screened, 95% confidence interval [CI]=5.62–7.14; P < .001), and combined DBT and S2D (7.40 per 1,000 screened, 95% CI = 6.49–8.37; P < .001) compared to DM alone (4.68 per 1,000 screened, 95% CI = 4.28–5.11). Invasive CDR was highest in combined DBT and DM (4.53 per 1,000 screened, 95% CI = 3.97–5.12, P = .003), and combined DBT and S2D (5.68 per 1,000 screened, 95% CI = 4.43–7.09; P < .001) compared to DM alone (3.42 per 1,000 screened, 95% CI = 3.02–3.83). Recall rate was lowest in combined DBT and S2D (42.3%, 95% CI = 37.4%–60.4%, P < .001). PPV1 was highest in combined DBT and DM (10.0%, 95% CI = 8.0–12.0; P = .004), and combined DBT and S2D (16.0%, 95% CI = 10.0–23.0; P < .001), while no difference was detected for DBT alone (7.0%, 95% CI = 6.0%–8.0%; P = .75) compared to DM alone (7.0%, 95.0% CI = 5.0%–8.0%).
Conclusion
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.
Protocol of a systematic review and meta-analysis comparing digital breast tomosynthesis (DBT) plus synthesized two-dimensional mammography (s2D) to digital mammography (DM) alone in breast cancer screening
