Accuracy of Digital Breast Tomosynthesis for Detecting Breast Cancer in the Diagnostic Setting: A Systematic Review and Meta-Analysis

Abstract

Objective To compare the accuracy for detecting breast cancer in the diagnostic setting between the use of digital breast tomosynthesis (DBT), defined as DBT alone or combined DBT and digital mammography (DM), and the use of DM alone through a systematic review and meta-analysis. Materials and Methods Ovid-MEDLINE, Ovid-Embase, Cochrane Library and five Korean local databases were searched for articles published until March 25, 2020. We selected studies that reported diagnostic accuracy in women who were recalled after screening or symptomatic. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate random effects model was used to estimate pooled sensitivity and specificity. We compared the diagnostic accuracy between DBT and DM alone using meta-regression and subgroup analyses by modality of intervention, country, existence of calcifications, breast density, Breast Imaging Reporting and Data System category threshold, study design, protocol for participant sampling, sample size, reason for diagnostic examination, and number of readers who interpreted the studies. Results Twenty studies (n = 44513) that compared DBT and DM alone were included. The pooled sensitivity and specificity were 0.90 (95% confidence interval [CI] 0.86–0.93) and 0.90 (95% CI 0.84–0.94), respectively, for DBT, which were higher than 0.76 (95% CI 0.68–0.83) and 0.83 (95% CI 0.73–0.89), respectively, for DM alone ( p < 0.001). The area under the summary receiver operating characteristics curve was 0.95 (95% CI 0.93–0.97) for DBT and 0.86 (95% CI 0.82–0.88) for DM alone. The higher sensitivity and specificity of DBT than DM alone were consistently noted in most subgroup and meta-regression analyses. Conclusion Use of DBT was more accurate than DM alone for the diagnosis of breast cancer. Women with clinical symptoms or abnormal screening findings could be more effectively evaluated for breast cancer using DBT, which has a superior diagnostic performance compared to DM alone.

Quality Reporting of Systematic Review and Meta-Analysis According to PRISMA 2020 Guidelines: Results from Recently Published Papers in the Korean Journal of Radiology

“…Briefly, 18 studies (14 univariate and four bivariate) were systematic reviews with meta-analyses [ 14 15 19 20 21 22 23 24 25 26 27 28 29 31 32 33 34 35 ] and six studies were systematic reviews without meta-analyses [ 16 17 18 30 36 37 ]. In terms of the type of data used for analyses, 13 studies used dichotomous data to measure the following outcomes: 1) efficacy or safety of an intervention (proportion of tumor response, recurrence, or treatment-related complications), 2) efficacy of a diagnostic test (proportion of technical failure and unreliable measurement), 3) imaging features in a certain disease (proportion of specific imaging findings), 4) evaluation of study quality or reporting quality (proportion of studies that met the specific criteria), and 5) diagnostic yield [ 14 15 18 19 22 23 24 28 32 33 34 35 36 ]; six studies used time-to-event data to calculate the efficacy of a new intervention or the reliability between overall survival and imaging surrogate markers [ 15 22 31 32 33 34 ]; six studies used diagnostic test data to pool the diagnostic performance of index tests [ 16 25 26 27 29 37 ]; two studies used continuous data to evaluate the agreement and reliability of measurements between imaging methods [ 20 21 ]; one study used descriptive data from imaging protocols in randomized controlled trials of acute ischemic stroke [ 30 ]; and one study used qualitative and quantitative data to assess the health-related quality-of-life in patients with hepatocellular carcinoma [ 17 ]. The number of included studies ranged from 4 to 516, with the majority (83%, 20 out of 24) of the articles including more than 10 studies.…”

“…Seven articles [ 16 24 27 30 31 32 36 ] did not report how many reviewers participated in the evaluation of study eligibility or whether they worked independently (item #8). Eighteen articles [ 16 17 18 19 20 21 22 23 24 25 26 27 28 29 32 34 36 37 ] did not cite the studies that seemed to meet the inclusion criteria, but were excluded in the final stage or did not explain the reason for exclusion (item #16b).…”

“…For randomized controlled trials (RCTs), the Risk of Bias (RoB) tool or revised Jadad scale were implemented [ 32 33 34 ]. For non-RCTs, Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 [ 16 19 20 21 25 26 28 ], QUADAS [ 37 ], Risk of Bias Assessment tool for non-randomized studies [ 14 35 ], Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) [ 17 ], Newcastle Ottawa Scale [ 15 32 34 ], and the National Institute of Health (NIH) assessment tool were used [ 22 23 ]. Among the articles that evaluated the risk of bias, only seven provided the full assessment results of the individual studies [ 17 19 22 23 26 33 34 ].…”

“…Finally, 24 publications were included in our analysis ( Fig. 1 ) [ 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 ].…”

Monochromatic X-rays: The future of breast imaging

“…Despite these advances, major problems remain in imaging of dense and thick breasts at acceptable radiation doses. Research in recent years has shown that DBT can more accurately assess breast cancer size and stage than conventional mammography [3]. It has been shown to improve the detection rate of cancers in women with dense breasts when using supplemental tomosynthesis in addition to standard digital mammography and has comparable sensitivity in the detection of noncalcified breast lesions when compared with digital mammography carried out with additional views.…”