Comparison of Digital and Screen-Film Mammography for Breast-Cancer Screening: A Systematic Review and Meta-Analysis

Purpose: Digital mammography (DM) has replaced screen-film mammography (SFM). However, findings of comparisons between the performance indicators of DM and SFM for breast-cancer screening have been inconsistent. Moreover, the summarized results from studies comparing the performance of screening mammography according to device type vary over time. Therefore, this study aimed to compare the performance of DM and SFM using recently published data. Methods: The MEDLINE, Embase, and Cochrane Library databases were searched for paired studies, cohorts, and randomized controlled trials published through 2018 that compared the performance of DM and SFM. All studies comparing the diagnostic accuracy of DM and SFM in asymptomatic, average-risk women aged 40 years and older were included. Two reviewers independently assessed the study quality and extracted the data. Results: Thirteen studies were included in the meta-analysis. The pooled sensitivity (DM, 0.76 [95% confidence interval {CI}, 0.70-0.81]; SFM, 0.76 [95% CI, 0.70-0.81]), specificity (DM, 0.96 [95% CI, 0.94-0.97]; SFM, 0.97 [95% CI, 0.94-0.98]), and area under the receiver-operating characteristic curve (DM, 0.94 [95% CI, 0.92-0.96]; SFM, 0.92 [95% CI, 0.89-0.94]) were similar for both DM and SFM. The pooled screening performance indicators reinforced superior accuracy of full-field DM, which is a more advanced type of mammography, than SFM. The advantage of DM appeared greater among women aged 50 years or older. There was high heterogeneity among studies in the pooled sensitivity, specificity, and overall diagnostic accuracy estimates. Stratifying by study design (prospective or retrospective) and removing studies with a 2-year or greater follow-up period resulted in homogeneous overall diagnostic accuracy estimates. Conclusion: The breast-cancer screening performance of DM is similar to that of SFM. The diagnostic performance of DM depends on the study design, and, in terms of performance, full-field DM is superior to SFM, unlike computed radiography systems.