[A review of the scientific evidence concerning the clinical application of digital mammography].
OBJECTIVE
To review the scientific evidence with respect to the use of digital mammography and compare it with analogical mammography in the clinical context.


METHODS
We searched Medline and EMbase for studies published between 1989 and 2005 that compared the results of digital and analogical mammography in the same group of patients or in two different groups of patients to evaluate their respective diagnostic accuracy (sensitivity, specificity, area under the ROC curve), recall rate, biopsy rate, and exposure to radiation. We reviewed and compared the different methodologies of the studies published.


RESULTS
Eight articles and eight presentations at congresses were found. No statistically significant differences were observed between digital and analogical mammography for the detection of breast cancer. Until the publication of the Oslo II (2004) and Digital Mammographic Imaging Screening Trial (2005) studies, the series presented were small and used a variety of methodologies. This made it impossible to appreciate small differences in diagnostic accuracy between the two techniques and to group the, sometimes, contradictory results. Furthermore, these first series did not include follow-up.


CONCLUSIONS
There are no statistically significant differences between the two techniques for diagnostic accuracy, except in women with dense or heterogeneously dense breasts, in those under 50 years of age, and in peri- or pre-menopausal women, in which cases digital mammography is significantly better. These data should be confirmed in longer term studies to enable the effects on the breast cancer mortality rate to be specifically evaluated. Cost-effectiveness studies are important when considering changing techniques.
Carreira Gómez
C
C
Servicio de Diagnóstico por Imagen, Hospital de Fuenlabrada, Madrid, Spain. ccarreira.hflr@salud.madrid.org
Martínez Cantarero
J
J
Gómez Santos
D
D
Polanco Sánchez
C
C
Naranjo García
P
P
del Llano Señarís
J
J
D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008327:Mammography; D011856:Radiographic Image Enhancement