Breast cancer screening using synthesized two-dimensional mammography: A systematic review and meta-analysis

Purpose: We conducted a systematic review and meta-analysis to compare the screening performance of synthesized mammography (SM) plus digital breast tomosynthesis (DBT) with digital mammography (DM) plus DBT or DM alone. Methods: Medline, Embase, Web of Science, and the Cochrane Library databases were searched from January 2010 to January 2021. Eligible population-based studies on breast cancer screening comparing SM/DBT with DM/DBT or DM in asymptomatic women were included. A random-effect model was used in this meta-analysis. Data were summarized as risk differences (RDs), with 95 % confidence intervals (CIs). Results: Thirteen studies involving 1,370,670 participants were included. Compared with DM/DBT, screening using SM/DBT had similar breast cancer detection rate (CDR) (RD =-0.1/1000 screens, 95 % CI =-0.4 to 0.2, p = 0.557, I-2 = 0 %), but lower recall rate (RD =-0.56 %, 95 % CI =-1.03 to-0.08, p = 0.022, I-2 = 90 %) and lower biopsy rate (RD =-0.33 %, 95 % CI =-0.56 to-0.10, p = 0.005, I-2 = 78 %). Compared with DM, SM/DBT improved CDR (RD = 2.0/1000 screens, 95 % CI = 1.4 to 2.6, p < 0.001, I-2 = 63 %) and reduced recall rate (RD =-0.95 %, 95 % CI =-1.91 to-0.002, p = 0.049, I-2 = 99 %). However, SM/DBT and DM had similar interval cancer rate (ICR) (RD = 0.1/1000 screens, 95 % CI =-0.6 to 0.8, p = 0.836, I-2 = 71 %) and biopsy rate (RD =-0.05 %, 95 % CI =-0.35 to 0.24, p = 0.727, I-2 = 93 %). Conclusions: Screening using SM/DBT has similar breast cancer detection but reduces recall and biopsy when compared with DM/DBT. SM/DBT improves CDR when compared with DM, but they have little difference in ICR. SM/DBT could replace DM/DBT in breast cancer screening to reduce radiation dose. (C) 2021 The Authors. Published by Elsevier Ltd.