Synthetic 2D Mammography Versus Standard 2D Digital Mammography: A Diagnostic Test Accuracy Systematic Review and Meta-Analysis.

ABSTRACT

BACKGROUND. The use of synthetic 2D mammography (SM) with digital breast tomosynthesis (DBT) in place of standard 2D digital mammography (DM) may reduce radiation dose without sacrificing accuracy. OBJECTIVE. The purpose of our study was to compare the diagnostic accuracy of SM, DM, SM with DBT, and DM with DBT for breast cancer detection. EVIDENCE ACQUISITION. A search of MEDLINE, Embase, and Cochrane databases was performed for relevant articles published up to September 11, 2019. Studies included compared the diagnostic accuracy of SM versus DM and SM plus DBT versus DM plus DBT for breast cancer detection. Relevant study data metrics and risk of bias were assessed. A bivariate random-effects meta-analysis and meta-regression were performed to assess diagnostic accuracy (PROSPERO CRD42020150737). EVIDENCE SYNTHESIS. Thirteen studies reporting on 201,304 patients (7252 patients with breast cancer) were included. The SM group (six studies 20,728 patients, 724 with breast cancer) had 75% sensitivity (95% CI, 67-82%) and 92% specificity (95% CI, 85-96%). The DM group (nine studies 52,082 patients, 2249 patients with breast cancer) had 73% sensitivity (95% CI, 65-80%) and 88% specificity (95% CI, 77-94%). The SM plus DBT group (10 studies, 64,224 patients, 2149 with breast cancer) had 85% sensitivity (95% CI, 80-89%) and 93% specificity (95% CI, 86-96%). The DM plus DBT group (nine studies, 64,270 patients, 2130 with breast cancer) had 84% sensitivity (95% CI, 80-88%) and 91% specificity (95% CI, 83-95%). Meta-regression models did not reveal significant differences in accuracy between the SM and DM groups (p = .25-.77). CONCLUSION. SM and SM plus DBT showed comparable diagnostic accuracy to DM and DM plus DBT, respectively. CLINICAL IMPACT. The findings support the implementation of SM in place of standard DM for mammographic imaging of the breasts. This may lead to an overall reduction in radiation exposure.