Pathologic Characteristics of Breast Cancers Detected With Digital Mammography Versus Digital Breast Tomosynthesis: A Pooled Comparative Analysis.

RATIONALE AND OBJECTIVES: Although digital breast tomosynthesis (DBT) improves screening performance relative to digital mammography (DM), it remains uncertain whether DBT changes the pathologic profile of detected cancers. We compared tumor grade, nodal status, tumor size, receptor markers, and related pathology features across comparative screening studies. METHODS: We searched PubMed, Embase, and the Cochrane Library through February 2026. Thirteen comparative screening studies were summarized in the protocol/context table, and six comparative screening studies contributed extractable data to at least one quantitative pathology endpoint. The primary grade analysis included 809 invasive cancers (261 DBT-detected and 548 DM-detected), and the nodal-status analysis included 818 invasive cancers (263 DBT-detected and 555 DM-detected). We used mixed-effects logistic regression with a study-level random intercept and random-effects risk-difference meta-analysis as a sensitivity analysis. RESULTS: Mixed-effects models showed insufficient evidence of major between-modality differences for grade 3 tumors (DM 35.7% [95% CI, 23.8%-49.7%] vs DBT 29.7% [18.8%-43.5%]; P=.15), node-positive disease (36.8% [31.6%-42.4%] vs 32.8% [27.2%-39.0%]; P=.16), tumor size >10 mm (78.0% [63.7%-87.7%] vs 75.0% [59.4%-86.0%]; P=.44), triple-negative phenotype, HER2 positivity, ER/PR positivity, or Ki67 positivity. Receptor and Ki67 analyses were limited by sparse reporting and heterogeneous source definitions. CONCLUSION: Current comparative evidence suggests that DBT increases detection of breast cancers without demonstrating a consistent shift in pathologic profile relative to DM. These findings should be interpreted cautiously because study protocols, pathology reporting, and endpoint availability varied across studies.