Department of Radiology, McMaster University, Hamilton, ON, Canada.
Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Eur Radiol. 2020 Apr;30(4):2058-2071. doi: 10.1007/s00330-019-06549-2. Epub 2020 Jan 3.
No consensus exists on digital breast tomosynthesis (DBT) utilization for breast cancer detection. We performed a diagnostic test accuracy systematic review and meta-analysis comparing DBT, combined DBT and digital mammography (DM), and DM alone for breast cancer detection in average-risk women.
MEDLINE and EMBASE were searched until September 2018. Comparative design studies reporting on the diagnostic accuracy of DBT and/or DM for breast cancer detection were included. Demographic, methodologic, and diagnostic accuracy data were extracted. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. Accuracy metrics were pooled using bivariate random-effects meta-analysis. The impact of multiple covariates was assessed using meta-regression.
CRD 42018111287.
Thirty-eight studies reporting on 488,099 patients (13,923 with breast cancer) were included. Eleven studies were at low risk of bias. DBT alone, combined DBT and DM, and DM alone demonstrated sensitivities of 88% (95% confidence interval [CI] 83-92), 88% (CI 83-92), and 79% (CI 75-82), as well as specificities of 84% (CI 76-89), 81% (CI 73-88), and 79% (CI 71-85), respectively. The greater sensitivities of DBT alone and combined DBT and DM compared to DM alone were preserved in the combined meta-regression models accounting for other covariates (p = 0.003-0.006). No significant difference in diagnostic accuracy between DBT alone and combined DBT and DM was identified (p = 0.175-0.581).
DBT is more sensitive than DM, while the addition of DM to DBT provides no additional diagnostic benefit. Consideration of these findings in breast cancer imaging guidelines is recommended.
• Digital breast tomosynthesis with or without additional digital mammography is more sensitive in detecting breast cancer than digital mammography alone in women at average risk for breast cancer. • The addition of digital mammography to digital breast tomosynthesis provides no additional diagnostic benefit in detecting breast cancer compared to digital breast tomosynthesis alone. • The specificity of digital breast tomosynthesis with or without additional digital mammography is no different than digital mammography alone in the detection of breast cancer.
目前对于数字乳腺断层合成术（DBT）在乳腺癌检测中的应用尚未达成共识。我们进行了一项诊断准确性系统评价和荟萃分析，比较了 DBT、DBT 联合数字乳腺摄影（DM）和 DM 单独用于平均风险女性乳腺癌检测的情况。
检索 MEDLINE 和 EMBASE 数据库，检索时间截至 2018 年 9 月。纳入比较设计研究，这些研究报告了 DBT 和/或 DM 对乳腺癌检测的诊断准确性。提取人口统计学、方法学和诊断准确性数据。使用 QUADAS-2 工具评估偏倚风险。使用双变量随机效应荟萃分析汇总准确性指标。使用元回归评估多个协变量的影响。
PROSPERO 注册号：CRD 42018111287。
纳入 38 项研究，共报道 488099 例患者（13923 例患有乳腺癌）。11 项研究的偏倚风险较低。DBT 单独、DBT 联合 DM 和 DM 单独的敏感性分别为 88%（95%置信区间 [CI] 83-92）、88%（CI 83-92）和 79%（CI 75-82），特异性分别为 84%（CI 76-89）、81%（CI 73-88）和 79%（CI 71-85）。在考虑了其他协变量的联合元回归模型中，DBT 单独和 DBT 联合 DM 的敏感性优于 DM 单独（p = 0.003-0.006）。未发现 DBT 单独和 DBT 联合 DM 之间的诊断准确性有显著差异（p = 0.175-0.581）。
与 DM 相比，DBT 更敏感，而在 DBT 中添加 DM 并不能提供额外的诊断益处。建议在乳腺癌影像学指南中考虑这些发现。
在平均风险的乳腺癌女性中，与数字乳腺摄影单独使用相比，数字乳腺断层合成术联合或不联合数字乳腺摄影在乳腺癌检测中更敏感。
在乳腺癌检测中，与单独使用数字乳腺断层合成术相比，在数字乳腺断层合成术中添加数字乳腺摄影没有提供额外的诊断益处。
数字乳腺断层合成术联合或不联合数字乳腺摄影检测乳腺癌的特异性与数字乳腺摄影单独使用时相同。
