Houssami Nehmat, Zackrisson Sophia, Blazek Katrina, Hunter Kylie, Bernardi Daniela, Lång Kristina, Hofvind Solveig
Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Department of Translational Medicine, Diagnostic Radiology, Lund University, Skane University Hospital, Malmö, Sweden.
Eur J Cancer. 2021 May;148:14-23. doi: 10.1016/j.ejca.2021.01.035. Epub 2021 Mar 9.
Breast cancer (BC) screening using digital breast tomosynthesis (DBT) has been shown to increase cancer detection compared with mammography; however, it is unknown whether DBT impacts interval cancer rate (ICR).
We systematically identified prospective DBT studies reporting data on screen-detected and interval BCs to perform a study-level meta-analysis of the comparative effect of DBT on ICR in population screening. Meta-analysis of cancer detection rate (CDR), ICR, and the differences between DBT and mammography in CDR and ICR pooled estimates, included random-effects. Sensitivity analysis examined whether study methods (imaging used, comparison group design, interval BC ascertainment) affected pooled estimates.
Five eligible prospective (non-randomised) studies of DBT population screening reported on 129,969 DBT-screened participants and 227,882 mammography-only screens, including follow-up publications reporting interval BC data. Pooled CDR was 9.03/1000 (95% confidence interval [CI] 8.53-9.56) for DBT, and 5.95/1000 (95% CI 5.65-6.28) for mammography: the pooled difference in CDR was 3.15/1000 (95% CI 2.53-3.77), and was evident for the detection of invasive and in-situ malignancy. Pooled ICR was 1.56/1000 DBT screens (95% CI 1.22-2.00), and 1.75/1000 mammography screens (95% CI 1.46-2.11): the estimated pooled difference in ICR was -0.15/1000 (95% CI -0.59 to 0.29) and was not substantially altered in several sensitivity analyses.
Meta-analysis shows consistent evidence that DBT significantly increased CDR compared with mammography screening; however, there was little difference between DBT and mammography in pooled ICR. This could suggest, but does not demonstrate, some over-detection. Meta-analysis using individual participant data, randomised trials and comparative studies quantifying cumulative detection and ICR over repeat DBT screen-rounds would provide valuable evidence to inform screening programs.
与乳腺钼靶检查相比，使用数字乳腺断层合成（DBT）进行乳腺癌（BC）筛查已被证明可提高癌症检出率；然而，DBT是否会影响间期癌发生率（ICR）尚不清楚。
我们系统地检索了报告筛查发现的乳腺癌和间期乳腺癌数据的前瞻性DBT研究，以对DBT在人群筛查中对ICR的比较效果进行研究水平的荟萃分析。对癌症检出率（CDR）、ICR以及DBT与乳腺钼靶检查在CDR和ICR合并估计值方面的差异进行荟萃分析，采用随机效应模型。敏感性分析检查研究方法（使用的成像、对照组设计、间期乳腺癌的确定）是否影响合并估计值。
五项符合条件的关于DBT人群筛查的前瞻性（非随机）研究报告了129,969名接受DBT筛查的参与者和227,882名仅接受乳腺钼靶检查的参与者，包括报告间期乳腺癌数据的后续出版物。DBT的合并CDR为9.03/1000（95%置信区间[CI]8.53 - 9.56），乳腺钼靶检查为5.95/1000（95%CI 5.65 - 6.28）：CDR的合并差异为3.15/1000（95%CI 2.53 - 3.77），在浸润性和原位恶性肿瘤的检测中均很明显。DBT筛查的合并ICR为1.56/1000（95%CI 1.22 - 2.00），乳腺钼靶检查为1.75/1000（95%CI 1.46 - 2.11）：ICR的估计合并差异为 - 0.15/1000（95%CI - 0.59至0.29），在多项敏感性分析中未发生实质性改变。
荟萃分析显示一致的证据表明，与乳腺钼靶筛查相比，DBT显著提高了CDR；然而，DBT与乳腺钼靶检查在合并ICR方面几乎没有差异。这可能提示，但未证明，存在一些过度诊断。使用个体参与者数据、随机试验和比较研究进行荟萃分析，量化重复DBT筛查轮次中的累积检出率和ICR，将为筛查计划提供有价值的证据。
