Comparison of Diagnostic Test Accuracy of Cone-Beam Breast Computed Tomography and Digital Breast Tomosynthesis for Breast Cancer: A Systematic Review and Meta-Analysis Approach.

BACKGROUND: Cone-beam breast computed tomography (CBBCT) and digital breast tomosynthesis (DBT) remain the main 3D modalities for X-ray breast imaging. This study aimed to systematically evaluate and meta-analyze the comparison of diagnostic accuracy of CBBCT and DBT to characterize breast cancers. METHODS: Two independent reviewers identified screening on diagnostic studies from 1 January 2015 to 30 December 2021, with at least reported sensitivity and specificity for both CBBCT and DBT. A univariate pooled meta-analysis was performed using the random-effects model to estimate the sensitivity and specificity while other diagnostic parameters like the area under the ROC curve (AUC), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were estimated using the bivariate model. RESULTS: The pooled sensitivity specificity, LR+ and LR- and AUC at 95% confidence interval are 86.7% (80.3-91.2), 87.0% (79.9-91.8), 6.28 (4.40-8.96), 0.17 (0.12-0.25) and 0.925 for the 17 included studies in DBT arm, respectively, while, 83.7% (54.6-95.7), 71.3% (47.5-87.2), 2.71 (1.39-5.29), 0.20 (0.04-1.05), and 0.831 are the pooled sensitivity specificity, LR+ and LR- and AUC for the five studies in the CBBCT arm, respectively. CONCLUSIONS: Our study demonstrates that DBT shows improved diagnostic performance over CBBCT regarding all estimated diagnostic parameters; with the statistical improvement in the AUC of DBT over CBBCT. The CBBCT might be a useful modality for breast cancer detection, thus we recommend more prospective studies on CBBCT application.

Macro problems from microplastics: Toward a sustainable policy framework for managing microplastic waste in Africa.

Microplastic pollution is a ubiquitous and emerging environmental and public health concern in Africa due to increased plastic production, product and waste importation, and usage. While studies on the environmental monitoring and characterization of microplastics demonstrated the urgent need for a drastic reduction in plastic waste generation, the effectiveness of the various regulatory and policy interventions implemented or proposed in Africa countries remains poorly understood. We critically examined policies, legislations, and regulations enacted to control microplastic pollution in Africa to develop a sustainable, harmonized framework for the coordinated reduction of plastic waste generation across Africa. Analysis of the interventions revealed most African countries employed traditional perspective (i.e., command-and-control) approaches, whereby state instruments such as plastic ban, production and importation levies, and consumer taxes were enacted. However, the continued increase in microplastic waste generation suggests traditional perspective approaches might not be effective in Africa. Although rarely used in Africa, market-oriented approaches such as private-public waste management are often effective in controlling plastic pollution. Hence, we proposed a bottom-up hybrid regulatory approach for managing microplastics pollution in Africa, involving price-based, right-base, legislation and behavioral frameworks based on best practices in microplastic waste management.