Review

乳腺癌筛查中断层合成成像结合合成乳腺X线摄影对比全数字乳腺摄影（含/不含断层合成）的诊断性能：系统综述与Meta分析

Diagnostic performance of tomosynthesis plus synthetic mammography versus full-field digital mammography with or without tomosynthesis in breast cancer screening: A systematic review and meta-analysis

INTERNATIONAL JOURNAL OF CANCER

影响因子:4.7

分区:医学2区 / 肿瘤学2区

发表日期:2025 Mar 01

作者: Wasim Hamad, Michael J Michell, Jonathan P Myles, Fiona J Gilbert, Yan Chen, Huajie Jin, John Loveland, Mark Halling-Brown, Keshthra Satchithananda, Juliet Morel, Rema Wasan, Caroline Taylor, Nisha Sharma, Alexandra Valencia, Will Teh, Faisal Majid, Ronald M De Visser, Asif Iqbal, Stephen W Duffy

DOI: 10.1002/ijc.35217

摘要

数字乳腺断层成像（Digital Breast Tomosynthesis, DBT）结合全数字乳腺摄影（Full-Field Digital Mammography, FFDM）可能会增加女性的辐射剂量。合成二维乳腺X线摄影（Synthetic 2D Mammogram, S2D）是从DBT构建的二维图像。我们旨在评估单独使用或联合DBT的S2D的性能，与单独或联合FFDM的效果进行比较。纳入的研究为招募筛查人群并报告S2D性能的研究。排除条件包括有症状患者、用于诊断的影像、或具有乳腺癌史的患者。对报告癌症检测率（Cancer Detection Rate, CDR）和特异性（Specificity）的研究进行了Meta分析，计算不同影像方式性能差异。分析显示，报告中DBT加S2D与FFDM的每千例检测到的癌症数差异为2.03（95% CI 0.81-3.25），而DBT加S2D与DBT加FFDM的差异为-0.15（95% CI -1.17至0.86）。在比较DBT加S2D和FFDM的研究中，特异性的差异估计值为1.13（95% CI -0.06至2.31），而在比较DBT加S2D与DBT加FFDM的研究中，差异为1.08（95% CI 0.59-1.56）。DBT加S2D在癌症检测率方面与FFDM加DPT相当，并且改善了癌症检测能力，单独使用或联合应用于乳腺癌筛查安全有效，且能保持检测性能。

Abstract

Digital breast tomosynthesis (DBT) with full-field digital mammography (FFDM) exposes women to a higher radiation dose. A synthetic 2D mammogram (S2D) is a two-dimensional image constructed from DBT. We aim to evaluate the S2D performance when used alone or combined with DBT compared to FFDM alone or with DBT. Studies were included if they recruited screening participants and reported on S2D performance. Studies were excluded if they included symptomatic patients, imaging was for diagnostic purposes, or if participants had a breast cancer history. Meta-analyses for cancer detection rates (CDR) and Specificities were conducted where available. Differences in the performance of imaging modalities were calculated within individual studies, and these were pooled by meta-analysis. Out of 3241 records identified, 17 studies were included in the review and 13 in the meta-analysis. The estimated combined difference in CDRs per thousand among individual studies that reported on DBT plus S2D vs. FFDM and those reporting on DBT plus S2D versus DBT plus FFDM was 2.03 (95% CI 0.81-3.25) and - 0.15 (95% CI -1.17 to 0.86), respectively. The estimated difference in percent specificities was 1.13 (95% CI -0.06 to 2.31) in studies comparing DBT plus S2D and FFDM. In studies comparing DBT plus S2D and DBT plus FFDM, the estimated difference in specificities was 1.08 (95% CI 0.59-1.56). DBT plus S2D showed comparable accuracy to FFDM plus DPT and improved cancer detection to FFDM alone. Integrating S2D with DBT in breast cancer screening is safe and preserves performance.