Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Jun 1;113(6):680-690.
doi: 10.1093/jnci/djaa205.

Performance of Digital Breast Tomosynthesis, Synthetic Mammography, and Digital Mammography in Breast Cancer Screening: A Systematic Review and Meta-Analysis

Mostafa Alabousi  1 , Akshay Wadera  1 , Mohammed Kashif Al-Ghita  2 , Rayeh Kashef Al-Ghetaa  3 , Jean-Paul Salameh  4 , Alex Pozdnyakov  5 , Nanxi Zha  1 , Lucy Samoilov  1 , Anahita Dehmoobad Sharifabadi  1 , Behnam Sadeghirad  6 , Vivianne Freitas  7 , Matthew Df McInnes  8 , Abdullah Alabousi  9
Affiliations
Meta-Analysis

Performance of Digital Breast Tomosynthesis, Synthetic Mammography, and Digital Mammography in Breast Cancer Screening: A Systematic Review and Meta-Analysis

Mostafa Alabousi et al. J Natl Cancer Inst. .

Abstract

Background: Our objective was to perform a systematic review and meta-analysis comparing the breast cancer detection rate (CDR), invasive CDR, recall rate, and positive predictive value 1 (PPV1) of digital mammography (DM) alone, combined digital breast tomosynthesis (DBT) and DM, combined DBT and synthetic 2-dimensional mammography (S2D), and DBT alone.

Methods: MEDLINE and Embase were searched until April 2020 to identify comparative design studies reporting on patients undergoing routine breast cancer screening. Random effects model proportional meta-analyses estimated CDR, invasive CDR, recall rate, and PPV1. Meta-regression modeling was used to compare imaging modalities. All statistical tests were 2-sided.

Results: Forty-two studies reporting on 2 606 296 patients (13 003 breast cancer cases) were included. CDR was highest in combined DBT and DM (6.36 per 1000 screened, 95% confidence interval [CI] = 5.62 to 7.14, P < .001), and combined DBT and S2D (7.40 per 1000 screened, 95% CI = 6.49 to 8.37, P < .001) compared with DM alone (4.68 per 1000 screened, 95% CI = 4.28 to 5.11). Invasive CDR was highest in combined DBT and DM (4.53 per 1000 screened, 95% CI = 3.97 to 5.12, P = .003) and combined DBT and S2D (5.68 per 1000 screened, 95% CI = 4.43 to 7.09, P < .001) compared with DM alone (3.42 per 1000 screened, 95% CI = 3.02 to 3.83). Recall rate was lowest in combined DBT and S2D (42.3 per 1000 screened, 95% CI = 37.4 to 60.4, P<.001). PPV1 was highest in combined DBT and DM (10.0%, 95% CI = 8.0% to 12.0%, P = .004), and combined DBT and S2D (16.0%, 95% CI = 10.0% to 23.0%, P < .001), whereas no difference was detected for DBT alone (7.0%, 95% CI = 6.0% to 8.0%, P = .75) compared with DM alone (7.0%, 95.0% CI = 5.0% to 8.0%).

Conclusions: Our findings provide evidence on key performance metrics for DM, DBT alone, combined DBT and DM, and combined DBT and S2D, which may inform optimal application of these modalities for breast cancer screening.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Study flow diagram. DBT = digital breast tomosynthesis; DM = digital mammography; S2D = synthetic 2D image.
Figure 2.
Figure 2.
Forest plots and pooled estimates of cancer detection rate (CDR). Results are shown for (A) digital mammography (DM), (B) digital breast tomosynthesis (DBT) + DM, (C) DBT + synthetic 2-dimensional image (S2D), and (D) DBT. The dotted line represents the pooled summary estimate of the pooled CDR with the diamond illustrating the associated 95% confidence interval (CI). The squares represent the CDR for individual studies, with the solid lines associated with them representing the 95% confidence intervals. ES = effect size.
Figure 3.
Figure 3.
Forest plots and pooled estimates of invasive cancer detection rate (CDR). Results are shown for (A) digital mammography (DM), (B) digital breast tomosynthesis (DBT) + DM, (C) DBT + synthetic 2-dimensional image (S2D), and (D) DBT. The dotted line represents the pooled summary estimate of the pooled invasive CDR with the diamond illustrating the associated 95% confidence interval. The squares represent the invasive CDR for individual studies, with the solid lines associated with them representing the 95% confidence interval (CI). ES = effect size.
Figure 4.
Figure 4.
Forest plots and pooled estimates of recall rate. Results are shown for (A) digital mammography (DM), (B) digital breast tomosynthesis (DBT) + DM, (C) DBT + synthetic 2-dimensional image (S2D), and (D) DBT. The dotted line represents the pooled summary estimate of the pooled recall rate with the diamond illustrating the associated 95% confidence interval (CI). The squares represent the recall rate for individual studies, with the solid lines associated with them representing the 95% confidence interval (CI). ES = effect size.
Figure 5.
Figure 5.
Forest plots and pooled estimates of PPV1. Results are shown for (A) digital mammography (DM), (B) digital breast tomosynthesis (DBT) + DM, (C) DBT + synthetic 2-dimensional image (S2D), and (D) DBT. The dotted line represents the pooled summary estimate of the pooled positive predictive value (PPV1) with the diamond illustrating the associated 95% confidence interval. The squares represent the PPV1 for individual studies, with the solid lines associated with them representing the 95% confidence interval (CI). ES = effect size.
See this image and copyright information in PMC

References

    1. Alsheik NH, Dabbous F, Pohlman SK, et al. Comparison of resource utilization and clinical outcomes following screening with digital breast tomosynthesis versus digital mammography: findings from a learning health system. Acad Radiol. 2019;26(5):597–605. - PubMed
    1. Boroumand G, Teberian I, Parker L, Rao VM, Levin DC. Screening mammography and digital breast tomosynthesis: utilization updates. Am J Roentgenol. 2018;210(5):1092–1096. - PubMed
    1. Sardanelli F, Fallenberg EM, Clauser P, et al.; for the European Society of Breast Imaging (EUSOBI), with language review by Europa Donna-The European Breast Cancer Coalition. Mammography: an update of the EUSOBI recommendations on information for women. Insights Imaging. 2017;8(1):11–18. - PMC - PubMed
    1. Bernardi D, Macaskill P, Pellegrini M, et al. Breast cancer screening with tomosynthesis (3D mammography) with acquired or synthetic 2D mammography compared with 2D mammography alone (STORM-2): a population-based prospective study. Lancet Oncol. 2016;17(8):1105–1113. - PubMed
    1. Conant EF, Beaber EF, Sprague BL, et al. Breast cancer screening using tomosynthesis in combination with digital mammography compared to digital mammography alone: a cohort study within the PROSPR consortium. Breast Cancer Res Treat. 2016;156(1):109–116. - PMC - PubMed