Document Type : Systematic Review and Meta-analysis
Authors
1
Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
2
Clinical Epidemiology and Biostatistics Unit (CEBU), Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
3
Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Indonesia.
4
Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia.
Abstract
Background: Breast cancer is a prevalent malignancy worldwide, with a growing number of survivors requiring post-treatment surveillance to improve outcomes. Radiologic surveillance, particularly mammography, is essential for early detection, however, there are disparities in the accuracy and effectiveness of various imaging modalities. Objectives: The aim of this systematic review and meta-analysis is to evaluate the effectiveness of radiology surveillance techniques for breast cancer survivors, focusing on diagnostic accuracy and mortality reduction. Methods: Studies assessing radiologic surveillance (e.g. mammography, ultrasonography, magnetic resonance imaging [MRI], and digital breast tomosynthesis) were included in this review. A comprehensive literature search was conducted in Medline, Cochrane Central Register of Controlled Trials, and Scopus databases. To obtain pooled estimates for sensitivity, specificity, accuracy, and mortality, we extracted and synthesized data using a random-effects model. The Newcastle-Ottawa Scale and QUADAS-2 instruments were used to assess the risk of bias. Results: A total of eighteen studies met the eligibility criteria for the review, of which eight were included in the meta-analysis (three for diagnostic accuracy and five for mortality. The pooled sensitivity, specificity, and accuracy of mammographic surveillance were 81% (95% CI 0.63-0.91), 71% (95% CI 0.31-0.93), and 76% (95% CI 0.59-0.88). A 50% reduction in mortality risk was linked to mammographic surveillance (OR 0.50; 95% CI 0.27-0.92). Heterogeneity was substantial for mortality analysis (I2=93%), while there was a low heterogeneity for the sensitivity analysis (I2=16%). MRI showed better sensitivity (91%) and specificity (82%) than ultrasonography and mammography. Conclusion: Although mammographic surveillance has a lower diagnostic accuracy than that observed in the screening population, it considerably lowers mortality among breast cancer survivors. The use of adjunct imaging modalities, such as MRI, may enhance early detection. Standardized surveillance protocols and further research on imaging strategies in diverse populations are required to improve post-treatment monitoring and patient outcomes.
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