Digital tomosynthesis in breast cancer: A systematic review

Abstract

Objective: To estimate and compare the diagnostic validity of tomosynthesis and digital mammography for screening and diagnosing breast cancer.

Material and methods: We systematically searched MedLine, EMBASE, and Web of Science for the terms breast cancer, screening, tomosynthesis, mammography, sensitivity, and specificity in publications in the period comprising June 2010 through February 2013. We included studies on diagnostic tests and systematic reviews. Two reviewers selected and evaluated the articles. We used QUADAS 2 to evaluate the risk of bias and the NICE criteria to determine the level of evidence. We compiled a narrative synthesis.

Results: Of the 151 original studies identified, we selected 11 that included a total of 2475 women. The overall quality was low, with a risk of bias and follow-up and limitations regarding the applicability of the results. The level of evidence was not greater than level II. The sensitivity of tomosynthesis ranged from 69% to 100% and the specificity ranged from 54% to 100%. The negative likelihood ratio was good, and this makes tomosynthesis useful as a test to confirm a diagnosis. One-view tomosynthesis was no better than two-view digital mammography, and the evidence for the superiority of two-view tomosynthesis was inconclusive.

Conclusions: The results for the diagnostic validity of tomosynthesis in the diagnosis of breast cancer were inconclusive and there were no results for its use in screening.

Keywords: Breast cancer; Cribado; Cáncer de mama; Imagen tridimensional; Mammography; Mamografía; Screening; Sensibilidad y especificidad; Sensitivity and specificity; Three-dimensional imaging; Tomosynthesis; Tomosíntesis.