Benefit of adding digital breast tomosynthesis to digital mammography for breast cancer screening focused on cancer characteristics: a meta-analysis

Yun, Seong Jong; Ryu, Chang‐Woo; Rhee, Sun Jung; Ryu, Jung Kyu; Oh, Ji Young

doi:10.1007/s10549-017-4298-1

Cited by 64 publications

(51 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, the numbers of detected breast cancers were too small for meaningful statistical comparisons. While initial studies suggested that the increased detection rate of tomosynthesis mostly involved invasive breast cancer, our results are similar to the preliminary findings of a more recent randomised controlled trial which found that tomosynthesis increased the detection of both invasive and in situ malignancies . More frequent cancer detection by tomosynthesis screening than in standard 2D mammography could indicate that it is more sensitive than standard mammography, but if it reflects increased detection of indolent malignancy it may not be associated with improved health outcomes.…”

Section: Discussionsupporting

confidence: 86%

Pilot trial of digital breast tomosynthesis (3D mammography) for population‐based screening in BreastScreen Victoria

Houssami

Lockie

Clemson

et al. 2019

Medical Journal of Australia

View full text Add to dashboard Cite

Objectives: To estimate detection measures for tomosynthesis and standard mammography; to assess the feasibility of using tomosynthesis in population-based screening for breast cancer.Design, setting: Prospective pilot trial comparing tomosynthesis (with synthesised 2D images) and standard mammography screening of women attending Maroondah BreastScreen, a BreastScreen Victoria service in the eastern suburbs of Melbourne.Participants: Women at least 40 years of age who presented for routine breast screening between 18 August 2017 and 8 November 2018. Main outcome measures:Cancer detection rate (CDR); proportion of screens that led to recall for further assessment.Results: 5018 tomosynthesis and 5166 standard mammography screens were undertaken in 10 146 women; 508 women (5.0% of screens) opted not to undergo tomosynthesis screening. With tomosynthesis, 49 cancers (40 invasive, 9 in situ) were detected (CDR, 9.8 [95% CI, 7.2-13] per 1000 screens); with standard mammography, 34 cancers (30 invasive, 4 in situ) were detected (CDR, 6.6 [95% CI, 4.6-9.2] per 1000 screens). The estimated difference in CDR was 3.2 more detections (95% CI, -0.32 to 6.8) per 1000 screens with tomosynthesis; the difference was greater for repeat screens and for women aged 60 years or more. The recall rate was greater for tomosynthesis (4.2%; 95% CI, 3.6-4.8%) than standard mammography (3.0%; 95% CI, 2.6-3.5%; estimated difference, 1.2%; 95% CI, 0.46-1.9%). The median screen reading time for tomosynthesis was 67 seconds (interquartile range [IQR] 46-105 seconds); for standard mammography, 16 seconds (IQR, 10-29 seconds). Conclusions:Breast cancer detection, recall for assessment, and screen reading time were each higher for tomosynthesis than for standard mammography. Our preliminary findings could form the basis of a large scale comparative evaluation of tomosynthesis and standard mammography for breast screening in Australia.Trial registration: Australian New Zealand Clinical Trials Registry, AC TRN12617000947303.The known: Overseas studies have found that digital breast tomosynthesis (3D mammography) can increase breast cancer detection rates and reduce the frequency of unnecessary recalls for assessment.The new: Our prospective pilot trial of population-based tomosynthesis screening in Maroondah BreastScreen found that more breast cancers were detected by tomosynthesis (9.8 [95% CI, 7.2-13] per 1000 screens) than by standard mammography (6.6 [95% CI, 4.6-9.2] per 1000 screens), but the recall rate was also higher (4.2% v 3.0%). The implications:Tomosynthesis breast screening is feasible if infrastructure and service preparation are adequate. Our findings could inform larger evaluations of tomosynthesis and standard mammography for breast screening in BreastScreen.

show abstract

Section: Discussionsupporting

confidence: 86%

Pilot trial of digital breast tomosynthesis (3D mammography) for population‐based screening in BreastScreen Victoria

Houssami

Lockie

Clemson

et al. 2019

Medical Journal of Australia

View full text Add to dashboard Cite

show abstract

“…Recall rate was reduced when using DBT compared to DM alone in screening studies using two study groups (RR = 0.72, 95% CI 0.64-0.80), though heterogeneity across studies was very high Almost all of the reviews in the literature comparing DBT with DM in BC screening do not distinctly report on women with dense breasts. One review, not restricted to women with dense breasts, reported that DBT with DM increased CDR with a RR of 1.29 (95% CI 1.16-1.43) (Yun et al [31]) which is comparable to our estimate. We identified only two reviews reporting on women with dense breasts, one was a quantitative rapid review and one was a narrative review without analyses [14,15].…”

Section: Discussionsupporting

confidence: 88%

Digital breast tomosynthesis for breast cancer screening and diagnosis in women with dense breasts – a systematic review and meta-analysis

Phi¹,

Tagliafico²,

Houssami³

et al. 2018

European Journal of Cancer

View full text Add to dashboard Cite

Background: This study aimed to systematically review and to meta-analyse the accuracy of digital breast tomosynthesis (DBT) versus digital mammography (DM) in women with mammographically dense breasts in screening and diagnosis. Methods: Two independent reviewers identified screening or diagnostic studies reporting at least one of four outcomes (cancer detection rate-CDR, recall rate, sensitivity and specificity) for DBT and DM in women with mammographically dense breasts. Study quality was assessed using QUADAS-2. Meta-analysis of CDR and recall rate used a random effects model. Summary ROC curve summarized sensitivity and specificity. Results: Sixteen studies were included (five diagnostic; eleven screening). In diagnosis, DBT increased sensitivity (84%-90%) versus DM alone (69%-86%) but not specificity. DBT improved CDR versus DM alone (RR: 1.16, 95% CI 1. 02-1.31). In screening, DBT + DM increased CDR versus DM alone (RR: 1.33, 95% CI 1.20-1.47 for retrospective studies; RR: 1.52, 95% CI 1.08-2.11 for prospective studies). Recall rate was significantly reduced by DBT + DM in retrospective studies (RR: 0.72, 95% CI 0.64-0.80) but not in two prospective studies (RR: 1.12, 95% CI 0.76-1.63). Conclusion: In women with mammographically dense breasts, DBT+/−DM increased CDR significantly (versus DM) in screening and diagnosis. In diagnosis, DBT+/−DM increased sensitivity but not specificity. The effect of DBT + DM on recall rate in screening dense breasts varied between studies.

show abstract

“…Almost all of the reviews in the literature comparing DBT with DM in BC screening do not distinctly report on women with dense breasts. One review, not restricted to women with dense breasts, reported that DBT with DM increased CDR with a RR of 1.29 (95% CI 1.16–1.43) (Yun et al [ 31 ]) which is comparable to our estimate. We identified only two reviews reporting on women with dense breasts, one was a quantitative rapid review and one was a narrative review without analyses [ 14 , 15 ].…”

Section: Discussionsupporting

confidence: 87%

Digital breast tomosynthesis for breast cancer screening and diagnosis in women with dense breasts – a systematic review and meta-analysis

et al. 2018

View full text Add to dashboard Cite

BackgroundThis study aimed to systematically review and to meta-analyse the accuracy of digital breast tomosynthesis (DBT) versus digital mammography (DM) in women with mammographically dense breasts in screening and diagnosis.MethodsTwo independent reviewers identified screening or diagnostic studies reporting at least one of four outcomes (cancer detection rate-CDR, recall rate, sensitivity and specificity) for DBT and DM in women with mammographically dense breasts. Study quality was assessed using QUADAS-2. Meta-analysis of CDR and recall rate used a random effects model. Summary ROC curve summarized sensitivity and specificity.ResultsSixteen studies were included (five diagnostic; eleven screening). In diagnosis, DBT increased sensitivity (84%–90%) versus DM alone (69%–86%) but not specificity. DBT improved CDR versus DM alone (RR: 1.16, 95% CI 1.02–1.31). In screening, DBT + DM increased CDR versus DM alone (RR: 1.33, 95% CI 1.20–1.47 for retrospective studies; RR: 1.52, 95% CI 1.08–2.11 for prospective studies). Recall rate was significantly reduced by DBT + DM in retrospective studies (RR: 0.72, 95% CI 0.64–0.80) but not in two prospective studies (RR: 1.12, 95% CI 0.76–1.63).ConclusionIn women with mammographically dense breasts, DBT+/−DM increased CDR significantly (versus DM) in screening and diagnosis. In diagnosis, DBT+/−DM increased sensitivity but not specificity. The effect of DBT + DM on recall rate in screening dense breasts varied between studies.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4263-3) contains supplementary material, which is available to authorized users.

show abstract

Benefit of adding digital breast tomosynthesis to digital mammography for breast cancer screening focused on cancer characteristics: a meta-analysis

Abstract: Adding DBT to FFDM enabled detection of early invasive breast cancer that might have been missed with FFDM alone. Knowing which cancer characteristic DBT detects may allow it to play a complementary role in predicting long-term patient outcomes and facilitate treatment planning.

Cited by 64 publications

References 34 publications

Pilot trial of digital breast tomosynthesis (3D mammography) for population‐based screening in BreastScreen Victoria

Pilot trial of digital breast tomosynthesis (3D mammography) for population‐based screening in BreastScreen Victoria

Digital breast tomosynthesis for breast cancer screening and diagnosis in women with dense breasts – a systematic review and meta-analysis

Digital breast tomosynthesis for breast cancer screening and diagnosis in women with dense breasts – a systematic review and meta-analysis

Contact Info

Product

Resources

About