Should breast tomosynthesis replace mammography for breast cancer detection : a systematic review

Abstract

Background: Breast cancer is the commonest cancer for women worldwide, with nearly 1.7 million new cases in 2012. In the past 20 years breast cancer has remained the number one cancer affecting women in Hong Kong. Mammogram remains the first line screening or diagnostic tool, and the most commonly performed procedure for breast cancer detection. Tomosynthesis, or digital breast tomosynthesis (DBT) was a new technology invented a few years ago aiming to reduce the problem of overlapping shadows in conventional mammogram. It is widely used in western countries, while there is only limited availability in Hong Kong. The objectives of this paper are to compare performance of conventional mammography with breast tomosynthesis, and see whether the new imaging modality could replace the conventional one.

Methods: A literature search was performed using PubMed to locate all relevant articles that compare the diagnostic accuracy of breast tomosynthesis with mammography from 2010 up to December 2014. Systematic review of 19 studies was performed.

Findings: Most studies showed that combined use of breast tomosynthesis and mammography significantly reduced recall rate, as a screening tool. Only one study compared breast tomosynthesis alone with 2D mammography as a screening tool, which also showed significant reduction in recall rate. Concerning cancer detection rate, the results appeared controversial, some studies showed increase cancer detection rate, while others showed no significant difference. Concerning diagnostic accuracy, most studies showed improvement in diagnostic accuracy, in terms of sensitivity and specificity.

Conclusions: Breast tomosynethesis appears to be a promising screening tool to detect breast cancer, in terms of cancer detection rate and recall rate. In countries where there is population screening, breast tomosynthesis may be a good substitute for conventional mammography, but it is expected that more studies may be required for such use to be commonly practiced. In Hong Kong, where there is no population screening programme, there may not be urge for introducing breast tomosynthesis to be used as screening tool. However, in public hospital, where most cases are referred cases and under specialist care, use of complimentary breast tomosynthesis is still controvertial.