Department of Epidemiology, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, The Netherlands.
Department of Health Sciences (Dissal), University of Genova and Ospedale Policlinico San Martino, Via L.B.Alberti 2, 16139, Genoa, Italy.
BMC Cancer. 2018 Apr 3;18(1):380. doi: 10.1186/s12885-018-4263-3.
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.
Two 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.
Sixteen 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).
In 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.
本研究旨在系统回顾和荟萃分析数字乳腺断层合成术（DBT）与数字乳腺摄影术（DM）在乳腺致密的女性筛查和诊断中的准确性。
两位独立的审查员确定了至少报告了以下四个结果（癌症检出率-CDR、召回率、敏感性和特异性）之一的筛查或诊断研究：在乳腺致密的女性中使用 DBT 和 DM 的研究。使用 QUADAS-2 评估研究质量。使用随机效应模型对 CDR 和召回率进行荟萃分析。汇总 ROC 曲线总结了敏感性和特异性。
纳入了 16 项研究（5 项诊断；11 项筛查）。在诊断中，DBT 提高了敏感性（84%-90%），优于单独使用 DM（69%-86%），但特异性无差异。DBT 提高了 CDR 与单独使用 DM（RR：1.16，95%CI 1.02-1.31）相比。在筛查中，DBT+DM 与单独使用 DM 相比增加了 CDR（RR：1.33，95%CI 1.20-1.47，用于回顾性研究；RR：1.52，95%CI 1.08-2.11，用于前瞻性研究）。DBT+DM 在回顾性研究中显著降低了召回率（RR：0.72，95%CI 0.64-0.80），但在两项前瞻性研究中则没有（RR：1.12，95%CI 0.76-1.63）。
在乳腺致密的女性中，DBT+/DM 显著增加了筛查和诊断中的 CDR（与 DM 相比）。在诊断中，DBT+/DM 提高了敏感性，但特异性无差异。DBT+/DM 对致密乳腺筛查中的召回率的影响在研究之间存在差异。
