Synthetic 2D Mammography Versus Standard 2D Digital Mammography: A Diagnostic Test Accuracy Systematic Review and Meta-Analysis

Abdullah, Peri; Alabousi, Mostafa; Ramadan, Sherif; Zawawi, Ismaiel; Zawawi, Mayar; Bhogadi, Yasovineeth; Freitas, Vivianne; Patlas, Michael N.; Alabousi, Abdullah

doi:10.2214/ajr.20.24204

Cited by 27 publications

(18 citation statements)

References 35 publications

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“…Furthermore, higher cancer detection per 100 women with recommended or performed biopsy underlines that DBT plus s2D is more precise in identifying cancers than DM alone. A 9%-point higher sensitivity (83%, 95% CI: 78-87%) for DBT plus s2D compared to DM alone (74%, 95% CI: 65-81%) was also reported by Abdullah et al [34].…”

Section: Results Interpretation and Comparison With Literaturesupporting

confidence: 66%

Digital breast tomosynthesis (DBT) plus synthesised two-dimensional mammography (s2D) in breast cancer screening is associated with higher cancer detection and lower recalls compared to digital mammography (DM) alone: results of a systematic review and meta-analysis

Heywang‐Köbrunner¹,

Jänsch²,

Hacker³

et al. 2021

Eur Radiol

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Objectives Digital breast tomosynthesis (DBT) plus digital mammography (DM) in screening is problematic due to increased radiation by the double exposure. Synthesised two-dimensional mammography (s2D) calculated from DBT datasets at no additional dose appears a sensible alternative compared to adding DM. This systematic review and meta-analysis focuses on screening performance outcomes in women screened with DBT plus s2D compared to DM alone. Methods PubMed was searched from January 1, 2010, to September 2, 2020. Studies comparing DBT plus s2D to DM alone in breast cancer screening were included. Pooled risk ratios (RR) were estimated for cancer detection rates (CDR), recall rates, interval cancer rates (ICR), biopsy rates, and positive predictive values for recalls (PPV-1), for biopsies recommended (PPV-2), and for biopsies performed (PPV-3). Sensitivity analyses were performed using the leave-one-out approach. Risk of bias (RoB) was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. Results Twelve papers covering 414,281 women were included from 766 records identified. CDR is increased ([RR, 95% CI] 1.35, 1.20–1.52), recall rates are decreased (0.79, 0.64–0.98), and PPV-1 is increased (1.69, 1.45–1.96) when using DBT plus s2D compared to DM alone. ICR and biopsy rates did not differ, but PPV-2 respectively PPV-3 increased with DBT plus s2D (1.57, 1.08–2.28 respectively 1.36, 1.17–1.58). Overall RoB of studies was assessed to be low. Conclusion Results show improved diagnostic outcomes with DBT plus s2D compared to DM alone and underline the value of DBT in combination with s2D in breast cancer screening. Key Points • DBT plus s2D is associated with higher CDR, lower recall rates, and a higher PPV-1 compared to DM alone in breast cancer screening. • No differences in biopsy rates were found between screening modalities, but PPV-2 and PPV-3 were higher in women screened with DBT plus s2D compared to DM alone. • We identified inconsistent results of ICR in two studies comparing DBT plus s2D to DM alone—resulting in no differences when pooling ICR in meta-analysis.

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Section: Results Interpretation and Comparison With Literaturesupporting

confidence: 66%

Digital breast tomosynthesis (DBT) plus synthesised two-dimensional mammography (s2D) in breast cancer screening is associated with higher cancer detection and lower recalls compared to digital mammography (DM) alone: results of a systematic review and meta-analysis

Heywang‐Köbrunner¹,

Jänsch²,

Hacker³

et al. 2021

Eur Radiol

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“…In addition, the radiologists in the RCT had insufficient experience in screen reading of DBT, so the radiologists may have not yet achieved optimal screen reading capabilities with DBT at the startup of the study [19]. Some studies have shown comparable diagnostic performance for the detection of cancer between SM/DBT and DM/DBT [11,45,46]. This suggests that SM may be used as an acceptable replacement for DM.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have shown comparable diagnostic performance for the detection of cancer between SM/DBT and DM/DBT [ 11 , 45 , 46 ]. This suggests that SM may be used as an acceptable replacement for DM.…”

Section: Discussionmentioning

confidence: 99%

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

Zeng

Gao

et al. 2021

The Breast

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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.

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“…In recent years there has been consistent evidence that synthesized mammography (synt2D) in place of conventional mammography in screening and symptomatic settings is at least the equal of standard 2D digital mammography in the detection of malignancy [6][7][8][9][10].…”

Section: Discussionmentioning

confidence: 99%

Lobular Breast Cancer Conspicuity on Digital Breast Tomosynthesis Compared to Synthesized 2D Mammography: A Multireader Study

Romanucci¹,

Zantedeschi²,

Ventriglia³

et al. 2021

J. Imaging

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Objectives: To compare the conspicuity of lobular breast cancers at digital breast tomosynthesis (DBT) versus synthesized 2D mammography (synt2D). Materials and methods: Seventy-six women (mean age 61.2 years, range 50–74 years) submitted to biopsy in our institution, from 2019 to 2021, with proven invasive lobular breast cancer (ILC) were enrolled in this retrospective study. The participants underwent DBT and synt2D. Five breast radiologists, with different years of experience in breast imaging, independently assigned a conspicuity score (ordinal 6-point scale) to DBT and synt2D. Lesion conspicuity was compared, for each reader, between the synt2D overall conspicuity interpretation and DBT overall conspicuity interpretation using a Wilcoxon matched pairs test. Results: A total of 50/78 (64%) cancers were detected on both synt2D and DBT by all the readers, while 28/78 (26%) cancers where not recognized by at least one reader on synt2D. For each reader, in comparison with synt2D, DBT increased significantly the conspicuity of ILC (p < 0.0001). The raw proportion of high versus low conspicuity by modality confirmed that cancers were more likely to have high conspicuity at DBT than synt2D. Conclusions: ILCs were more likely to have high conspicuity at DBT than at synt2D, increasing the chances of the detection of ILC breast cancer.

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Synthetic 2D Mammography Versus Standard 2D Digital Mammography: A Diagnostic Test Accuracy Systematic Review and Meta-Analysis

Cited by 27 publications

References 35 publications

Digital breast tomosynthesis (DBT) plus synthesised two-dimensional mammography (s2D) in breast cancer screening is associated with higher cancer detection and lower recalls compared to digital mammography (DM) alone: results of a systematic review and meta-analysis

Digital breast tomosynthesis (DBT) plus synthesised two-dimensional mammography (s2D) in breast cancer screening is associated with higher cancer detection and lower recalls compared to digital mammography (DM) alone: results of a systematic review and meta-analysis

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

Lobular Breast Cancer Conspicuity on Digital Breast Tomosynthesis Compared to Synthesized 2D Mammography: A Multireader Study

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