Corsetti V, Ferrari A, Ghirardi M, Bergonzini R, Bellarosa S, Angelini O, Bani C, Ciatto S
Ambulatori Oncologici Raphael, Via Vittorio Emanuele II, I-25011, Calcinato (BS), Italy.
Radiol Med. 2006 Apr;111(3):440-8. doi: 10.1007/s11547-006-0040-5. Epub 2006 Apr 11.
The purpose of this study was to assess the usefulness of routine ultrasonography in women with negative mammography and dense breasts [Breast Imaging Reporting and Data System (BIRADS D3-4)].
We applied a protocol involving routine ultrasonography in a consecutive series of subjects with negative mammography and dense breasts. After evaluation by internal and external reviewers of cancers detected by ultrasonography performed to confirm negative mammography, we determined the additional cancer detection rate of ultrasonography and the cost of the protocol.
Out of 17,883 total mammographies, 167 cancers were diagnosed (detection rate: 0.93%). Out of 257 suspicious mammographies, 138 cancers were detected. Out of 17,626 negative mammographies, 6,449 (36.5%) were classified as "dense breast" and underwent ultrasonography: 29 cancers were detected (detection rate: 0.44%, or 17.3% of total cancers). Out of 25 cancer cases reviewed, negative mammography and asymptomatic status was confirmed in 15 (detection rate 0.23%, or 8.9% of total cancers). The cancer detection rate was 0.11%, 0.22%, 0.32% and 0.14% for age groups <40, 40-49, 50-59 and >59, respectively. The cost per additional carcinoma detected by ultrasonography alone was euro 25,847.85 whereas that per examined woman was euro 21.68.
The study confirms the possibility that ultrasonography can detect mammographically occult breast carcinoma in dense breasts. The evidence is insufficient to recommend this policy in routine screening practice but suggests that, at least in current clinical practice, adding ultrasonography in dense breasts may be useful despite the substantial costs.
本研究旨在评估常规超声检查在乳腺钼靶检查阴性且乳腺致密的女性（乳腺影像报告和数据系统分类为BIRADS D3 - 4）中的应用价值。
我们对一系列乳腺钼靶检查阴性且乳腺致密的连续受试者应用了包含常规超声检查的方案。在内部和外部评审人员对为确认乳腺钼靶检查阴性而进行的超声检查所发现的癌症进行评估后，我们确定了超声检查的额外癌症检出率以及该方案的成本。
在总共17883例乳腺钼靶检查中，诊断出167例癌症（检出率：0.93%）。在257例可疑的乳腺钼靶检查中，检测到138例癌症。在17626例乳腺钼靶检查阴性的病例中，6449例（36.5%）被归类为“乳腺致密”并接受了超声检查：检测到29例癌症（检出率：0.44%，占总癌症的17.3%）。在审查的25例癌症病例中，15例确认乳腺钼靶检查阴性且无症状（检出率0.23%，占总癌症的8.9%）。年龄小于40岁、40 - 49岁、50 - 59岁和大于59岁的年龄组的癌症检出率分别为0.11%、0.22%、0.32%和0.14%。仅通过超声检查检测到的每例额外癌症的成本为25847.85欧元，而每位接受检查的女性的成本为21.68欧元。
该研究证实了超声检查能够在致密乳腺中检测出钼靶隐匿性乳腺癌的可能性。证据不足以在常规筛查实践中推荐这一策略，但表明至少在当前临床实践中，尽管成本高昂，但在致密乳腺中增加超声检查可能是有用的。
