National Reference Centre Mammography Munich, Sonnenstraße 29, 80331, Munich, Germany.
, FFB gGmbH, Munich, Germany.
Eur Radiol. 2022 Apr;32(4):2301-2312. doi: 10.1007/s00330-021-08308-8. Epub 2021 Oct 25.
Digital breast tomosynthesis (DBT) plus digital mammography (DM) in screening is problematic due to increased radiation by the double exposure. Synthesised two-dimensional mammography (s2D) calculated from DBT datasets at no additional dose appears a sensible alternative compared to adding DM. This systematic review and meta-analysis focuses on screening performance outcomes in women screened with DBT plus s2D compared to DM alone.
PubMed was searched from January 1, 2010, to September 2, 2020. Studies comparing DBT plus s2D to DM alone in breast cancer screening were included. Pooled risk ratios (RR) were estimated for cancer detection rates (CDR), recall rates, interval cancer rates (ICR), biopsy rates, and positive predictive values for recalls (PPV-1), for biopsies recommended (PPV-2), and for biopsies performed (PPV-3). Sensitivity analyses were performed using the leave-one-out approach. Risk of bias (RoB) was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool.
Twelve papers covering 414,281 women were included from 766 records identified. CDR is increased ([RR, 95% CI] 1.35, 1.20-1.52), recall rates are decreased (0.79, 0.64-0.98), and PPV-1 is increased (1.69, 1.45-1.96) when using DBT plus s2D compared to DM alone. ICR and biopsy rates did not differ, but PPV-2 respectively PPV-3 increased with DBT plus s2D (1.57, 1.08-2.28 respectively 1.36, 1.17-1.58). Overall RoB of studies was assessed to be low.
Results show improved diagnostic outcomes with DBT plus s2D compared to DM alone and underline the value of DBT in combination with s2D in breast cancer screening.
• DBT plus s2D is associated with higher CDR, lower recall rates, and a higher PPV-1 compared to DM alone in breast cancer screening. • No differences in biopsy rates were found between screening modalities, but PPV-2 and PPV-3 were higher in women screened with DBT plus s2D compared to DM alone. • We identified inconsistent results of ICR in two studies comparing DBT plus s2D to DM alone-resulting in no differences when pooling ICR in meta-analysis.
由于双重曝光，数字乳腺断层合成术（DBT）加数字乳腺摄影术（DM）在筛查中存在问题。从 DBT 数据集中计算出的合成二维乳腺摄影术（s2D）在不增加剂量的情况下似乎是一种明智的替代方法，而不是增加 DM。本系统评价和荟萃分析重点关注与单独使用 DM 相比，在接受 DBT 加 s2D 筛查的女性中筛查性能的结果。
从 2010 年 1 月 1 日至 2020 年 9 月 2 日，在 PubMed 上进行了检索。纳入了比较乳腺癌筛查中 DBT 加 s2D 与单独使用 DM 的研究。对于癌症检出率（CDR）、召回率、间期癌率（ICR）、活检率以及推荐活检的阳性预测值 1（PPV-1）、推荐活检的阳性预测值 2（PPV-2）和进行活检的阳性预测值 3（PPV-3），计算了合并风险比（RR）。使用剔除一个研究的方法进行敏感性分析。使用诊断准确性研究的质量评估（QUADAS-2）工具评估偏倚风险（RoB）。
从 766 条记录中确定了 12 篇涵盖 414281 名女性的论文。与单独使用 DM 相比，DBT 加 s2D 可增加 CDR（[RR，95%CI] 1.35，1.20-1.52）、降低召回率（0.79，0.64-0.98）和增加 PPV-1（1.69，1.45-1.96）。ICR 和活检率没有差异，但 DBT 加 s2D 后 PPV-2 和 PPV-3 分别增加（1.57，1.08-2.28 分别为 1.36，1.17-1.58）。研究的整体 RoB 被评估为低。
结果表明，与单独使用 DM 相比，DBT 加 s2D 可改善诊断结果，并强调了 DBT 在乳腺癌筛查中的组合应用在联合 s2D 时的价值。
• DBT 加 s2D 与单独使用 DM 相比，在乳腺癌筛查中可提高 CDR、降低召回率和增加 PPV-1。• 两种筛查方法的活检率没有差异，但 DBT 加 s2D 组的 PPV-2 和 PPV-3 高于单独使用 DM 组。• 我们发现，在两项比较 DBT 加 s2D 与单独使用 DM 的研究中，ICR 的结果不一致，因此在荟萃分析中合并 ICR 时没有差异。
