Breast cancer screening using synthesized two-dimensional mammography: A systematic review and meta-analysis

Abstract

We conducted a systematic review and meta-analysis to compare the screening performance of synthesized mammography (SM) plus digital breast tomosynthesis (DBT) with digital mammography (DM) plus DBT or DM alone. Methods: Medline, Embase, Web of Science, and the Cochrane Library databases were searched from January 2010 to January 2021. Eligible population-based studies on breast cancer screening comparing SM/DBT with DM/DBT or DM in asymptomatic women were included. A random-effect model was used in this meta-analysis. Data were summarized as risk differences (RDs), with 95 % confidence intervals (CIs). Results: Thirteen studies involving 1,370,670 participants were included. Compared with DM/DBT, screening using SM/DBT had similar breast cancer detection rate (CDR) (RD ¼ À0.1/1000 screens, 95 % CI ¼ À0.4 to 0.2, p ¼ 0.557, I 2 ¼ 0 %), but lower recall rate (RD ¼ À0.56 %, 95 % CI ¼ À1.03 to À0.08, p ¼ 0.022, I 2 ¼ 90 %) and lower biopsy rate (RD ¼ À0.33 %, 95 % CI ¼ À0.56 to À0.10, p ¼ 0.005, I 2 ¼ 78 %). Compared with DM, SM/DBT improved CDR (RD ¼ 2.0/1000 screens, 95 % CI ¼ 1.4 to 2.6, p < 0.001, I 2 ¼ 63 %) and reduced recall rate (RD ¼ À0.95 %, 95 % CI ¼ À1.91 to À0.002, p ¼ 0.049, I 2 ¼ 99 %). However, SM/DBT and DM had similar interval cancer rate (ICR) (RD ¼ 0.1/1000 screens, 95 % CI ¼ À0.6 to 0.8, p ¼ 0.836, I 2 ¼ 71 %) and biopsy rate (RD ¼ À0.05 %, 95 % CI ¼ À0.35 to 0.24, p ¼ 0.727, I 2 ¼ 93 %). Conclusions: Screening using SM/DBT has similar breast cancer detection but reduces recall and biopsy when compared with DM/DBT. SM/DBT improves CDR when compared with DM, but they have little difference in ICR. SM/DBT could replace DM/DBT in breast cancer screening to reduce radiation dose.

Our experience using synthesized mammography vs full field digital mammography in population-based screening

“…There was excellent agreement between the readers in BI-RADS category. We found high level of agreement between the SM+DBT and FFDM+DBT in each of the readers which is consistent with the results of systematic review conducted by Baoqi zeng et al suggesting SM+DBT could replace FFDM+DBT for breast cancer screening [15] .…”

“…David Gur et al, found that SM+DBT had comparable specificity, but slightly lower sensitivity compared with FFDM+DBT [20] , [21] . Conducted numerous clinical studies afterwards suggested comparable results between using SM+DBT and FFDM+DBT [10] , [11] , [12] , [13] , [14] , [15] .…”

“…Multiple studies are conducted to compare FFDM and SM [11] , [12] , [13] , [14] . Systematic review by Zeng B, concluded that FFDM can be omitted from the screening after implementing SM+DBT [15] . But not many similar studies are conducted in Middle East, which is suggested to have higher breast densities in normal population in comparison with Western communities [16] , [17] .…”

Comparisons between artificial intelligence computer-aided detection synthesized mammograms and digital mammograms when used alone and in combination with tomosynthesis images in a virtual screening setting

“…However, the use of DM + DBT implies a twofold increase in the radiation dose, which is not acceptable for the screening of asymptomatic women. Synthesized mammograms (SM) consist of twodimensional images that are generated from the DBT data to prevent exposure to additional radiation doses; SM + DBT have been used to replace DM + DBT for the screening process [1][2][3]. However, DBT is commonly used in combination with DM or SM.…”

Artificial intelligence computer-aided detection enhances synthesized mammograms: comparison with original digital mammograms alone and in combination with tomosynthesis images in an experimental setting

“…Additionally, SM maintains the benefits of DBT by accentuating the data volume on the single two-dimensional SM data. Three systemic reviews show that SM + DBT can replace DM + DBT in screening [1,4,5]. Also, several studies have successfully shown that SM alone as non-inferior to DM alone in a diagnostic setting [6][7][8].…”