PDF(Pubmed)
Abstract：
BACKGROUND: Digital breast tomosynthesis (DBT) may improve sensitivity in population screening. However, evidence is currently limited on the performance of DBT in patients at a higher risk of breast cancer. This systematic review compares the clinical effectiveness and cost-effectiveness of DBT, digital mammography (DM), and ultrasound, for breast cancer detection in women with dense breasts and additional risk factors.
METHODS: Medline, Embase, and Evidence-Based Medicine Reviews via OvidSP were searched to identify literature from 2010 to August 21, 2023. Selection of studies, data extraction, and quality assessment (using QUADAS-2 and CHEERS) were completed in duplicate. Findings were summarised descriptively and narratively.
RESULTS: Twenty-six studies met pre-specified inclusion criteria. In women with breast symptoms or recalled for investigation of screen-detected findings (19 studies), DBT may be more accurate than DM. For example, in symptomatic women, the sensitivity of DBT + DM ranged from 82.8 % to 92.5 % versus 56.8 %-81.3 % for mammography (DM/synthesised images). However, most studies had a high risk of bias due to participant selection. Evidence regarding DBT in women with a personal or family history of breast cancer, for DBT versus ultrasound alone, and cost-effectiveness of DBT was limited.
CONCLUSIONS: In women with dense breasts and additional risk factors for breast cancer, evidence is limited about the accuracy of DBT compared to other imaging modalities, particularly in those with personal or family history of breast cancer. Future research in this population should consider head-to-head comparisons of imaging modalities to determine the relative effectiveness of these imaging tests.
BACKGROUND: PROSPERO registration number CRD42021236470.
METHODS: Medline, Embase, and Evidence-Based Medicine Reviews via OvidSP were searched to identify literature from 2010 to August 21, 2023. Selection of studies, data extraction, and quality assessment (using QUADAS-2 and CHEERS) were completed in duplicate. Findings were summarised descriptively and narratively.
RESULTS: Twenty-six studies met pre-specified inclusion criteria. In women with breast symptoms or recalled for investigation of screen-detected findings (19 studies), DBT may be more accurate than DM. For example, in symptomatic women, the sensitivity of DBT + DM ranged from 82.8 % to 92.5 % versus 56.8 %-81.3 % for mammography (DM/synthesised images). However, most studies had a high risk of bias due to participant selection. Evidence regarding DBT in women with a personal or family history of breast cancer, for DBT versus ultrasound alone, and cost-effectiveness of DBT was limited.
CONCLUSIONS: In women with dense breasts and additional risk factors for breast cancer, evidence is limited about the accuracy of DBT compared to other imaging modalities, particularly in those with personal or family history of breast cancer. Future research in this population should consider head-to-head comparisons of imaging modalities to determine the relative effectiveness of these imaging tests.
BACKGROUND: PROSPERO registration number CRD42021236470.
摘要：
背景：数字乳腺断层合成（DBT）可能会提高人群筛查的敏感性。然而,目前关于乳腺癌高危患者DBT表现的证据有限.本系统评价比较了DBT的临床疗效和成本效益。数字乳腺摄影（DM），还有超声波,用于乳房致密和其他危险因素女性的乳腺癌检测。
方法：Medline，Embase,并通过OvidSP检索了2010年至2023年8月21日的循证医学评论，以确定文献。选择研究，数据提取,质量评估（使用QUADAS-2和CHEERS）一式两份完成。研究结果进行了描述性和叙述性总结。
结果：26项研究符合预先规定的纳入标准。在有乳房症状或被召回调查筛查发现的女性中（19项研究），DBT可能比DM更准确。例如,在有症状的女性中，DBT+DM的敏感度为82.8%~92.5%,而乳腺X线摄影(DM/合成图像)的敏感度为56.8%~81.3%.然而,由于参与者的选择,大多数研究存在较高的偏倚风险.关于有乳腺癌个人或家族史的女性DBT的证据，对于DBT与单独的超声，DBT的成本效益有限。
结论：在乳房致密且有其他乳腺癌危险因素的女性中，与其他成像方式相比，关于DBT准确性的证据有限，特别是那些有个人或家族乳腺癌病史的人。该人群的未来研究应考虑成像方式的头对头比较，以确定这些成像测试的相对有效性。
背景：PROSPERO注册号CRD42021236470。
方法：Medline，Embase,并通过OvidSP检索了2010年至2023年8月21日的循证医学评论，以确定文献。选择研究，数据提取,质量评估（使用QUADAS-2和CHEERS）一式两份完成。研究结果进行了描述性和叙述性总结。
结果：26项研究符合预先规定的纳入标准。在有乳房症状或被召回调查筛查发现的女性中（19项研究），DBT可能比DM更准确。例如,在有症状的女性中，DBT+DM的敏感度为82.8%~92.5%,而乳腺X线摄影(DM/合成图像)的敏感度为56.8%~81.3%.然而,由于参与者的选择,大多数研究存在较高的偏倚风险.关于有乳腺癌个人或家族史的女性DBT的证据，对于DBT与单独的超声，DBT的成本效益有限。
结论：在乳房致密且有其他乳腺癌危险因素的女性中，与其他成像方式相比，关于DBT准确性的证据有限，特别是那些有个人或家族乳腺癌病史的人。该人群的未来研究应考虑成像方式的头对头比较，以确定这些成像测试的相对有效性。
背景：PROSPERO注册号CRD42021236470。
