[Digital tomosynthesis for the diagnosis of breast cancer]

Pichon Riviere A, Augustovski F, Garcia Marti S, Alcaraz A, Glujovsky D, Lopez A, Rey-Ares L, Bardach A, Ciapponi A, Comandé D
Record ID 32014000253
Authors' objectives: To assess the available evidence on the efficacy, safety and coverage related aspects regarding DBT use for the diagnosis of breast cancer.
Authors' recomendations: The available evidence is of moderate methodological quality. As regards breast cancer diagnosis in the population with clinical or imaging suspicion, the studies assessed that included few patients suggest that DBT might be as effective as mammography. Specifically, the studies that measured the operating characteristics of DBT found that its performance was comparable to that of mammography, however, it should be considered that the only comparator assessed was mammography; therefore, the value of ultrasound and MRI has not been taken into account as diagnostic ancillary method. Adding DBT to diagnostic mammography proved, also in small studies, to increase the sensitivity, negative predictive value and area under the curve in a population with clinical or imaging suspected breast cancer. In terms of screening strategies in the general population, no studies assessing DBT as a single procedure have been found. Two studies showed an increase in the rate of cancer detection and area under the ROC curve and a decrease in the rate of false positives when adding DBT to mammography. However, the current evidence is not good enough to recommend general changes in the screening strategy or to support the use of DBT routinely for breast cancer diagnosis. There are also other barriers for the use of DBT as screening strategy that include its high cost and exposure to higher questionable radiation levels for screening population. DBT might be eventually considered as an intermediate step between diagnostic mammography and biopsy in certain selected cases, although there is still no clear consensus on what the definite role of DBT might be in the diagnostic process of patients who are being evaluated due to suspected lesions. Although DBT has shown excellent operating characteristics and might be a promising technology to continue under evaluation, most clinical practice guidelines and coverage policies do not consider DBT as an integral part of the screening process or pathological image evaluation yet; however this could be modified in the next few years as scientific evidence becomes available. Since mammography and ultrasound equipment are widely available, the conduct of studies of very strict methodology quality and with a large number of patients is considered highly required together with cost-effectiveness studies prior to widely adopting this new technology.
Project Status: Completed
Year Published: 2013
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Argentina
MeSH Terms
  • Humans
  • Breast Neoplasms
  • Tomography, X-Ray Computed
Organisation Name: Institute for Clinical Effectiveness and Health Policy
Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA
Contact Name: info@iecs.org.ar
Contact Email: info@iecs.org.ar
Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.