Breast cancer screening using synthesized two-dimensional mammography: A systematic review and meta-analysis
Baoqi Zeng, Kai Yu, Le Gao, Xueyang Zeng, Qingxin Zhou
Abstract
Purpose: 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 0.1/1000 screens, 95 % CI 0.4 to 0.2, p 0.557, I 2 0 %), but lower recall rate (RD 0.56 %, 95 % CI 1.03 to 0.08, p 0.022, I 2 90 %) and lower biopsy rate (RD 0.33 %, 95 % CI 0.56 to 0.10, p 0.005, I 2 78 %). Compared with DM, SM/DBT improved CDR (RD 2.0/1000 screens, 95 % CI 1.4 to 2.6, p < 0.001, I 2 63 %) and reduced recall rate (RD 0.95 %, 95 % CI 1.91 to 0.002, p 0.049, I 2 99 %). However, SM/DBT and DM had similar interval cancer rate (ICR) (RD 0.1/1000 screens, 95 % CI 0.6 to 0.8, p 0.836, I 2 71 %) and biopsy rate (RD 0.05 %, 95 % CI 0.35 to 0.24, p 0.727, I 2 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.