Comparison of common screening techniques
| Technique | Current recommendations | Advantages | Disadvantages | Sensitivity (%) | Specificity (%) | Recall rate (%) | PPV (%) | Cancer detection rate (per 1000) | Ref.* |
|---|---|---|---|---|---|---|---|---|---|
| Mammography | Recommended for women who have reached the initial age for breast cancer screening | Convenient; economical; sensitive to microcalcification | Insensitive to high density breasts and deep lesions | 69.0–86.0 | 57.0–96.6 | 3.5–4.0 | 13.0–22.9 | 3.2–7.1 | 38–42 |
| DBT | Recommended, particularly for women with dense breasts, replacing DM | 3D imaging, reducing tissue overlay | Greater radiation dose, examination time and cost | 82.6–89.0 | 72.0–97.6 | 3.1–3.9 | 20.7–21.4 | 4.6–9.4 | 38–42 |
| CEM | Recommended for women at high risk | Vascular functional imaging | Use of contrast agents; greater radiation dose | 87.5–92.7 | 67.9–93.7 | – | 11.9–20.9 | 13.1–15.5 | 43–45 |
| Ultrasound | Recommended, particularly for women with dense breasts, and pregnant and lactating women | Noninvasive; real-time; no radiation; elastography; identification of cystic and solid masses | Dependent on technologist experience; insensitive to lesions without clear mass | 80.0–90.6 | 81.0–94.5 | 4.1–6.9 | 3.0–6.6 | 4.4 | 46–48 |
| ABUS | Recommended, particularly for women with dense breasts, and pregnant and lactating women | Less dependent on technologist skill; reproducible | Unable to assess the axillary lymph node status | 67.6–99.8 | 74.6–91.6 | 1.5–13.5 | 4.1–5.4 | 1.8–15.1 | 46–48 |
| MRI | Recommended for women at high risk | Most precise identification of soft tissue; reflects both the anatomical structure and lesions; displays small lesions, multifocal lesions, and lesions located deep in the tissue | Insensitive to calcification; expensive; long examination time; use of contrast agents | 95.2–97.5 | 83.8–92.0 | 9.5 | 8.0–17.4 | 11.8–16.5 | 49–51 |
DBT, digital breast tomosynthesis; DM, digital mammography; CEM, contrast-enhanced mammography; ABUS, automated breast ultrasonography; MRI, magnetic resonance imaging; PPV, positive predictive value. *Most relevant studies with evidence grade IIb or above are included to illustrate the performance of most imaging techniques, which were essentially the results of randomized controlled experiments or systematic review and meta-analysis.