Tomosynthesis with synthesised two-dimensional mammography yields higher cancer detection compared to digital mammography alone, also in dense breasts and in younger women: A systematic review and meta-analysis

• Published in: European journal of radiology Vol. 152; p. 110324
• Main Authors: Heywang-Köbrunner, Sylvia-H., Jänsch, Alexander, Hacker, Astrid, Weinand, Sina, Vogelmann, Tobias
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.07.2022
• Subjects: Cancer detection; Dense breasts; Digital breast tomosynthesis; Meta-analysis; Recall rate; Synthesised digital mammography; Systematic review; ECIBC’s GDG; RR; RoB; s2D; Recall rate; Systematic review; Cancer detection; BI-RADS; DM; CDR; Dense breasts; DBT; VDG; ESM; Digital breast tomosynthesis; CI; PRISMA; Meta-analysis; FEM; PPV-3; PPV-1; PPV-2; ICR; REM; Synthesised digital mammography; QUADAS
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2022.110324

•To date little is known about screening performance outcomes of the combination DBT plus s2D stratified regarding age, breast density, and reading procedure. To our knowledge this is the first meta-analysis investigating this research question.•Breast cancer screening with DBT plus s2D compared to DM alone is associated with higher cancer detection rates (CDR), especially in women with high breast density and in double-reading. Age stratification resulted in small differences in CDR.•Recall rates were lower in high breast densities, but much lower for low breast densities in screening with DBT plus s2D versus DM alone; they strongly decreased mainly with non-double reading compared to double reading using DBT plus s2D versus DM alone.•As the statistical significance of meta-analysis results is limited by the low number of studies included, the presented results are intended to give a first overview of screening performance outcomes in subgroups based on currently available data. This systematic review and meta-analysis focuses on breast cancer screening performance outcomes stratified into breast density, age, and reading procedure using ‘digital breast tomosynthesis (DBT) with synthesised two-dimensional mammography (s2D)’ compared to ‘digital mammography (DM) alone’. Studies comparing ‘DBT with s2D’ and ‘DM’ were searched in PubMed and Cochrane library. Pooled risk ratios (RR) using fixed or random effects models (F-/REM) for cancer detection rates (CDR), recall rates, interval cancer rates (ICR), biopsy rates, and positive predictive values (PPV) 1–3 were calculated. Outcomes were stratified into breast density (non-dense and dense), age (<60, ≥60), and reading procedure (double-/non-double reading). Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. We identified 13 studies. Using DBT plus s2D compared to DM alone resulted in a higher increase in CDR for dense ([number of studies included, FEM RR, 95% confidence interval (CI)]; n = 3, 1.60, 1.16–2.22) versus non-dense breasts (n = 3, 1.32, 1.08–1.61). Recall rates were lower in dense (n = 2, 0.84, 0.75–0.94), but much lower for non-dense breasts (n = 2, 0.65, 0.59–0.72). Age stratification resulted in small differences in CDR (<60: n = 2, 1.64, 1.18–2.29 / ≥60: n = 2, 1.56, 1.19–2.05). After screening with DBT plus s2D compared to DM alone the risk of being recalled was less in non-double (n = 3, 0.57, 0.54–0.60) than in double reading (n = 5, 0.95, 0.81–1.11) and the risk of cancer detection was higher in double reading (n = 6, 1.53, 1.40–1.67) than in non-double reading (n = 4, 1.17, 1.02–1.33). Since only few studies are available for meta-analyses statistical significance strongly depends on single study results. Taking this into account, the most important results concern the increase of CDR in women with dense breasts, the increased CDR in double reading, and the lower recall rates particularly with non-double reading.