Liu Lei, Yu Chunyang, Fan Qiulan, Zeng Baoqi
Department of Science and Technology, Beijing Shijitan Hospital, Beijing, China.
Department of Ultrasound, Peking University Binhai Hospital (Tianjin Fifth Central Hospital), Tianjin, China.
Clin Exp Med. 2025 Jul 10;25(1):241. doi: 10.1007/s10238-025-01789-7.
To systematically determine the diagnostic accuracy of digital breast tomosynthesis (DBT) in combination with digital mammography (DM) compared with DM alone for breast cancer. We searched multiple English and Chinese databases from January 2010 to October 2023. Eligible diagnostic studies comparing DBT/DM with DM alone for breast cancer in women were included. QUADAS-2 tool was used to assess the risk of bias. The summary sensitivity, specificity, and diagnostic odds ratio (DOR) were estimated using a bivariate model. 27 studies with 45,694 individuals and 59,493 breast lesions were included. The pooled sensitivity and specificity of DBT/DM were 87% (95% confidence interval [CI], 84-90%) and 84% (95% CI, 78-88%), respectively. These values were higher than those of DM alone, with pooled sensitivity of 76% (95% CI, 72-79%) and specificity of 80% (95% CI, 73-86%). The pooled DORs for DBT/DM and DM alone were 34.74 (95% CI, 22.18-54.39) and 12.96 (95% CI, 8.80-19.08), respectively. Additionally, adding DBT to DM improved diagnostic performance more significantly in Asians (DORs, 59.47 vs. 16.10) than in Westerners (DORs, 19.48 vs. 10.30). Meta-regression analysis revealed that country, reference standard, and published language were significant factors (P < 0.05) affecting heterogeneity for DBT/DM. This meta-analysis demonstrated that DBT/DM has higher diagnostic accuracy than DM alone for breast cancer. Diagnosing breast cancer with DBT/DM significantly increased sensitivity and slightly increased specificity compared with DM alone. Furthermore, adding DBT to DM increased diagnostic performance more significantly in Asians than in Westerners.
为系统地确定数字乳腺断层合成（DBT）联合数字乳腺钼靶摄影（DM）与单纯DM相比对乳腺癌的诊断准确性。我们检索了2010年1月至2023年10月的多个英文和中文数据库。纳入了比较DBT/DM与单纯DM对女性乳腺癌诊断的符合条件的诊断性研究。使用QUADAS-2工具评估偏倚风险。采用双变量模型估计汇总敏感性、特异性和诊断比值比（DOR）。纳入了27项研究，涉及45,694名个体和59,493个乳腺病变。DBT/DM的汇总敏感性和特异性分别为87%（95%置信区间[CI]，84-90%）和84%（95%CI，78-88%）。这些值高于单纯DM，单纯DM的汇总敏感性为76%（95%CI，72-79%），特异性为80%（95%CI，73-86%）。DBT/DM和单纯DM的汇总DOR分别为34.74（95%CI，22.18-54.39）和12.96（95%CI，8.80-19.08）。此外，在亚洲人中，将DBT添加到DM中比在西方人中更显著地提高了诊断性能（DOR分别为59.47对16.10和19.48对10.30）。Meta回归分析显示，国家、参考标准和发表语言是影响DBT/DM异质性的显著因素（P<0.05）。该Meta分析表明，DBT/DM对乳腺癌的诊断准确性高于单纯DM。与单纯DM相比，使用DBT/DM诊断乳腺癌显著提高了敏感性，特异性略有提高。此外，在亚洲人中，将DBT添加到DM中比在西方人中更显著地提高了诊断性能。
