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      Digital breast tomosynthesis for breast cancer screening and diagnosis in women with dense breasts – a systematic review and meta-analysis

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          Abstract

          Background

          This study aimed to systematically review and to meta-analyse the accuracy of digital breast tomosynthesis (DBT) versus digital mammography (DM) in women with mammographically dense breasts in screening and diagnosis.

          Methods

          Two independent reviewers identified screening or diagnostic studies reporting at least one of four outcomes (cancer detection rate-CDR, recall rate, sensitivity and specificity) for DBT and DM in women with mammographically dense breasts. Study quality was assessed using QUADAS-2. Meta-analysis of CDR and recall rate used a random effects model. Summary ROC curve summarized sensitivity and specificity.

          Results

          Sixteen studies were included (five diagnostic; eleven screening). In diagnosis, DBT increased sensitivity (84%–90%) versus DM alone (69%–86%) but not specificity. DBT improved CDR versus DM alone (RR: 1.16, 95% CI 1.02–1.31). In screening, DBT + DM increased CDR versus DM alone (RR: 1.33, 95% CI 1.20–1.47 for retrospective studies; RR: 1.52, 95% CI 1.08–2.11 for prospective studies). Recall rate was significantly reduced by DBT + DM in retrospective studies (RR: 0.72, 95% CI 0.64–0.80) but not in two prospective studies (RR: 1.12, 95% CI 0.76–1.63).

          Conclusion

          In women with mammographically dense breasts, DBT+/−DM increased CDR significantly (versus DM) in screening and diagnosis. In diagnosis, DBT+/−DM increased sensitivity but not specificity. The effect of DBT + DM on recall rate in screening dense breasts varied between studies.

          Electronic supplementary material

          The online version of this article (10.1186/s12885-018-4263-3) contains supplementary material, which is available to authorized users.

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          Most cited references24

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          Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program.

          To assess cancer detection rates, false-positive rates before arbitration, positive predictive values for women recalled after arbitration, and the type of cancers detected with use of digital mammography alone and combined with tomosynthesis in a large prospective screening trial.
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            Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study.

            Digital breast tomosynthesis with 3D images might overcome some of the limitations of conventional 2D mammography for detection of breast cancer. We investigated the effect of integrated 2D and 3D mammography in population breast-cancer screening.
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              Breast cancer screening with tomosynthesis (3D mammography) with acquired or synthetic 2D mammography compared with 2D mammography alone (STORM-2): a population-based prospective study.

              Breast tomosynthesis (pseudo-3D mammography) improves breast cancer detection when added to 2D mammography. In this study, we examined whether integrating 3D mammography with either standard 2D mammography acquisitions or with synthetic 2D images (reconstructed from 3D mammography) would detect more cases of breast cancer than 2D mammography alone, to potentially reduce the radiation burden from the combination of 2D plus 3D acquisitions.
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                Author and article information

                Contributors
                +31 (0)50 3611450 , x.a.phi@umcg.nl
                albertotagliafico@gmail.com
                nehmat.houssami@syd.edu.au
                m.j.w.greuter@umcg.nl
                g.h.de.bock@umcg.nl
                Journal
                BMC Cancer
                BMC Cancer
                BMC Cancer
                BioMed Central (London )
                1471-2407
                3 April 2018
                3 April 2018
                2018
                : 18
                : 380
                Affiliations
                [1 ]ISNI 0000 0000 9558 4598, GRID grid.4494.d, Department of Epidemiology, , University Medical Center Groningen, ; Hanzeplein 1, PO Box 30.001, 9700RB Groningen, The Netherlands
                [2 ]ISNI 0000 0001 2151 3065, GRID grid.5606.5, Department of Health Sciences (Dissal), , University of Genova and Ospedale Policlinico San Martino, ; Via L.B.Alberti 2, 16139 Genoa, Italy
                [3 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, Sydney School of Public Health, Sydney Medical School, , The University of Sydney, ; Edward Ford Building (A27), Sydney, NSW 2006 Australia
                [4 ]ISNI 0000 0000 9558 4598, GRID grid.4494.d, Department of Radiology, , University Medical Center Groningen, ; Postbus 30 001, 9700RB Groningen, The Netherlands
                Author information
                http://orcid.org/0000-0003-0033-3369
                Article
                4263
                10.1186/s12885-018-4263-3
                5883365
                29615072
                65a4b0d4-5044-4363-a826-38d3de995a4d
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 31 August 2017
                : 20 March 2018
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Oncology & Radiotherapy
                breast neoplasm,digital mammography,digital breast tomosynthesis,review,meta-analysis,breast density

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