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)
Por:
Canelo-Aybar, C, Carrera, L, Beltran, J, Posso, M, Rigau, D, Lebeau, A, Grawingholt, A, Castells, X, Langendam, M, Perez, E, Rossi, PG, Van Engen, R, Parmelli, E, Saz-Parkinson, Z, Alonso-Coello, P
Publicada:
1 abr 2021
Ahead of Print:
1 mar 2021
Resumen:
Background Diagnostic mammography projections (DxMM) have been traditionally used in the assessment of women recalled after a suspicious screening mammogram. Digital breast tomosynthesis (DBT) reduces the tissue overlap effect, thus improving image assessment. Some studies have suggested DBT might replace DxMM with at least equivalent performance.
Objective To evaluate the replacement of DxMM with DBT in women recalled at screening.
Methods We searched PubMed, EMBASE, and the Cochrane Library databases to identify diagnostic paired cohort studies or RCTs comparing DBT vs DxMM, published in English that: reported accuracy outcomes, recruited women recalled for assessment at mammography screening, and included a reference standard. Subgroup analysis was performed over lesion characteristics. We provided pooled accuracy estimates and differences between tests using a quadrivariate model. We assessed the certainty of the evidence using the GRADE approach.
Results We included ten studies that reported specificity and sensitivity. One study included 7060 women while the remaining included between 52 and 738 women. DBT compared with DxMM showed a pooled difference for the sensitivity of 2% (95% CI 1%-3%) and a pooled difference for the specificity of 6% (95%CI 2%-11%). Restricting the analysis to the six studies that included women with microcalcification lesions gave similar results. In the context of a prevalence of 21% of breast cancer (BC) in recalled women, DBT probably detects 4 (95% CI 2-6) more BC cases and has 47 (95%CI 16-87) fewer false-positive results per 1000 assessments. The certainty of the evidence was moderate due to risk of bias.
Conclusion The evidence in the assessment of screen-recalled findings with DBT is sparse and of moderate certainty. DBT probably has higher sensitivity and specificity than DxMM. Women, health care providers and policymakers might value as relevant the reduction of false-positive results and related fewer invasive diagnostic procedures with DBT, without missing BC cases.
Filiaciones:
Canelo-Aybar, C:
CIBER Epidemiol & Salud Publ CIBERESP, Madrid, Spain
Biomed Res Inst St Pau IIB St Pau, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
Carrera, L:
Univ Nacl Mayor San Marcos, Lima, Peru
Beltran, J:
Biomed Res Inst St Pau IIB St Pau, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
Posso, M:
Biomed Res Inst St Pau IIB St Pau, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
Hosp del Mar Med Res Inst IMIM, Dept Epidemiol & Evaluat, Barcelona, Spain
Rigau, D:
Biomed Res Inst St Pau IIB St Pau, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
Lebeau, A:
Univ Med Ctr Hamburg Eppendorf, Inst Pathol, Hamburg, Germany
Grawingholt, A:
Radiol Theater, Paderborn, Germany
Castells, X:
Hosp del Mar Med Res Inst IMIM, Dept Epidemiol & Evaluat, Barcelona, Spain
Langendam, M:
Univ Amsterdam, Amsterdam Publ Hlth Inst, Dept Clin Epidemiol Biostat & Bioinformat, Amsterdam UMC, Amsterdam, Netherlands
Perez, E:
Univ Hosp Dr Josep Trueta, Girona, Spain
Rossi, PG:
Azienda USL IRCCS Reggio Emilia, Epidemiol Unit, Reggio Emilia, Italy
Van Engen, R:
Dutch Expert Ctr Screening, LRCB, Nijmegen, Netherlands
Parmelli, E:
European Commiss, Joint Res Ctr JRC, Via E Fermi 2749 TP127, I-21027 Ispra, VA, Italy
Saz-Parkinson, Z:
European Commiss, Joint Res Ctr JRC, Via E Fermi 2749 TP127, I-21027 Ispra, VA, Italy
Alonso-Coello, P:
CIBER Epidemiol & Salud Publ CIBERESP, Madrid, Spain
Biomed Res Inst St Pau IIB St Pau, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
gold, Green Published
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