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, Jessica; Posso, Margarita; Rigau, David; Lebeau, Annette; Gräwingholt, Axel; Castells, Xavier; Langendam, Miranda; Pérez, Elsa; Giorgi Rossi, Paolo; Engen, Ruben van; Parmelli, Elena; Saz Parkinson, Zuleika; Alonso Coello, Pablo

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)

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dc.contributor.author Canelo Aybar, Carlos
dc.contributor.author Carrera, Lourdes
dc.contributor.author Beltrán, Jessica
dc.contributor.author Posso, Margarita
dc.contributor.author Rigau, David
dc.contributor.author Lebeau, Annette
dc.contributor.author Gräwingholt, Axel
dc.contributor.author Castells, Xavier
dc.contributor.author Langendam, Miranda
dc.contributor.author Pérez, Elsa
dc.contributor.author Giorgi Rossi, Paolo
dc.contributor.author Engen, Ruben van
dc.contributor.author Parmelli, Elena
dc.contributor.author Saz Parkinson, Zuleika
dc.contributor.author Alonso Coello, Pablo
dc.date.accessioned 2021-04-21T08:06:32Z
dc.date.available 2021-04-21T08:06:32Z
dc.date.issued 2021
dc.description.abstract 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.
dc.format.mimetype application/pdf
dc.identifier.citation Canelo-Aybar C, Carrera L, Beltrán J, Posso M, Rigau D, Lebeau A, Gräwingholt A, Castells X, Langendam M, Pérez E, Giorgi Rossi P, Van Engen R, Parmelli E, Saz-Parkinson Z, Alonso-Coello P. 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). Cancer Med. 2021; 10(7):2191-204. DOI: 10.1002/cam4.3803
dc.identifier.doi http://dx.doi.org/10.1002/cam4.3803
dc.identifier.issn 2045-7634
dc.identifier.uri http://hdl.handle.net/10230/47174
dc.language.iso eng
dc.publisher Wiley
dc.relation.ispartof Cancer Med. 2021; 10(7):2191-204
dc.rights © 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.rights.uri http://creativecommons.org/licenses/by/4.0/
dc.subject.keyword Breast neoplasms
dc.subject.keyword Digital breast tomosyntheses
dc.subject.keyword Mass screening
dc.subject.keyword Practice guidelines
dc.subject.keyword Systematic review
dc.title 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)
dc.type info:eu-repo/semantics/article
dc.type.version info:eu-repo/semantics/publishedVersion

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