Digital breast tomosynthesis compared to diagnostic mammographic projections (including magnification) among women recalled at screening mammography: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC)

Canelo‐Aybar, Carlos; Carrera, Lourdes; Beltrán, J. De Juan; Posso, Margarita; Rigau, David; Lebeau, Annette; Gräwingholt, Axel; Castells, Xavier; Langendam, Miranda; Pérez, Elsa; Rossi, Paolo Giorgi; Engen, Ruben van; Parmelli, Elena; Saz‐Parkinson, Zuleika; Alonso‐Coello, Pablo

doi:10.1002/cam4.3803

Cited by 3 publications

(3 citation statements)

References 29 publications

(186 reference statements)

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“…Rigorous studies that enroll screening populations and report advanced cancer detection, morbidity, and mortality outcomes from multiple rounds of screening are needed to overcome persistent limitations in the evidence on breast cancer screening. Multiple screening rounds are essential to determine whether a screening modality or strategy reduces the risk of advanced cancer by detecting early cancers that would otherwise have progressed (stage shift), potentially reducing breast cancer morbidity and mortality …”

Section: Discussionmentioning

confidence: 99%

“…Study-defined advanced breast cancer outcomes were used when this outcome was not reported (eg, stage II or higher). Invasive breast cancer detection outcomes from multiple screening rounds can indicate whether a screening modality or strategy reduces the risk of advanced cancer by detecting early cancers that would otherwise have progressed (stage shift), thereby potentially reducing breast cancer morbidity and mortality …”

Section: Methodsmentioning

confidence: 99%

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Screening for Breast Cancer

Henderson,

Webber,

Weyrich

et al. 2024

JAMA

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ImportanceBreast cancer is a leading cause of cancer mortality for US women. Trials have established that screening mammography can reduce mortality risk, but optimal screening ages, intervals, and modalities for population screening guidelines remain unclear.ObjectiveTo review studies comparing different breast cancer screening strategies for the US Preventive Services Task Force.Data SourcesMEDLINE, Cochrane Library through August 22, 2022; literature surveillance through March 2024.Study SelectionEnglish-language publications; randomized clinical trials and nonrandomized studies comparing screening strategies; expanded criteria for screening harms.Data Extraction and SynthesisTwo reviewers independently assessed study eligibility and quality; data extracted from fair- and good-quality studies.Main Outcomes and MeasuresMortality, morbidity, progression to advanced cancer, interval cancers, screening harms.ResultsSeven randomized clinical trials and 13 nonrandomized studies were included; 2 nonrandomized studies reported mortality outcomes. A nonrandomized trial emulation study estimated no mortality difference for screening beyond age 74 years (adjusted hazard ratio, 1.00 [95% CI, 0.83 to 1.19]). Advanced cancer detection did not differ following annual or biennial screening intervals in a nonrandomized study. Three trials compared digital breast tomosynthesis (DBT) mammography screening with digital mammography alone. With DBT, more invasive cancers were detected at the first screening round than with digital mammography, but there were no statistically significant differences in interval cancers (pooled relative risk, 0.87 [95% CI, 0.64-1.17]; 3 studies [n = 130 196]; I2 = 0%). Risk of advanced cancer (stage II or higher) at the subsequent screening round was not statistically significant for DBT vs digital mammography in the individual trials. Limited evidence from trials and nonrandomized studies suggested lower recall rates with DBT. An RCT randomizing individuals with dense breasts to invitations for supplemental screening with magnetic resonance imaging reported reduced interval cancer risk (relative risk, 0.47 [95% CI, 0.29-0.77]) and additional false-positive recalls and biopsy results with the intervention; no longer-term advanced breast cancer incidence or morbidity and mortality outcomes were available. One RCT and 1 nonrandomized study of supplemental ultrasound screening reported additional false-positives and no differences in interval cancers.Conclusions and RelevanceEvidence comparing the effectiveness of different breast cancer screening strategies is inconclusive because key studies have not yet been completed and few studies have reported the stage shift or mortality outcomes necessary to assess relative benefits.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Screening for Breast Cancer

Henderson,

Webber,

Weyrich

et al. 2024

JAMA

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“…DBT represents a mammographic technique, involving mammograms from different angles to create computed tomosynthesis layered reconstructions of the breast 11 , 12 . Especially in the case of inhomogeneously dense breast parenchyma, DBT shows diagnostic advantages over conventional DM 8 , 13 – 17 . In detection of microcalcifications it shows similar results as DM 18 – 22 .…”

Section: Introductionmentioning

confidence: 99%

Accuracy of cone-beam computed tomography, digital mammography and digital breast tomosynthesis for microcalcifications and margins to microcalcifications in breast specimens

Neubauer

Yilmaz²,

Bronsert³

et al. 2022

Sci Rep

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Accurate determination of resection margins in breast specimens is important as complete removal of malignancy is a prerequisite for patients’ outcome. Mammography (DM) as 2D-technique provides only limited value in margin assessment. Therefore, we investigated whether cone-beam computed tomography (CBCT) or digital breast tomosynthesis (DBT) has incremental value in assessing margins to microcalcifications. Three independent readers investigated breast specimens for presence of microcalcifications and the smallest distance to margins. Histopathology served as gold standard. Microcalcifications were detected in 15 out of 21 included specimens (71%). Pooled sensitivity for DM, DBT and CBCT for microcalcifications compared to preoperative DM was 0.98 (CI 0.94–0.99), 0.83 (CI 0.73–0.94) and 0.94 (CI 0.87–0.99), pooled specificity was 0.99 (CI 0.99–0.99), 0.73 (CI 0.51–0.96) and 0.60 (CI 0.35–0.85). Mean measurement error for margin determination for DM, DBT and CBCT was 10 mm, 14 mm and 6 mm (p = 0.002) with significant difference between CBCT and the other devices (p < 0.03). Mean reading time required by the readers to analyze DM, DBT and CBCT, was 36, 43 and 54 s (p < 0.001). Although DM allows reliable detection of microcalcifications, measurement of resection margin was significantly more accurate with CBCT. Thus, a combination of methods or improved CBCT might provide a more accurate determination of disease-free margins in breast specimens.

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Impact of tomosynthesis on the evolution of the cancer detection rate in the French National Breast Cancer Screening Program

Balamou¹,

Koïvogui

Zysman³

et al. 2022

Public Health

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Digital breast tomosynthesis compared to diagnostic mammographic projections (including magnification) among women recalled at screening mammography: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC)

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 3 publications

References 29 publications

Screening for Breast Cancer

Screening for Breast Cancer

Accuracy of cone-beam computed tomography, digital mammography and digital breast tomosynthesis for microcalcifications and margins to microcalcifications in breast specimens

Impact of tomosynthesis on the evolution of the cancer detection rate in the French National Breast Cancer Screening Program

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