Brancato Beniamino, Bonardi Rita, Catarzi Sandra, Iacconi Chiara, Risso Gabriella, Taschini Renzo, Ciatto Stefano
Centro per lo Studio e la Prevenzione Oncologica, Florence, Italy.
Tumori. 2007 Nov-Dec;93(6):562-6. doi: 10.1177/030089160709300608.
To assess the role of breast ultrasonography as a complement to negative mammography in radiologically dense breasts.
Out of a total series of 49,044 consecutive mammograms reported as negative in asymptomatic women, 25,665 (52.3%) were coded as dense (BI-RADS D3-4) and ultrasonography was recommended. Due to organizational problems, ultrasonography was performed immediately or within 1 month only in 5,227 cases, representing the study series.
Two cancers were detected at immediate ultrasonography (0.03%). The cancer detection rate in women aged 40-49 and 50-69 years was 0.002% and 0.07%, respectively. The benign biopsy rate was 0.5% for core biopsies and 0.02% for surgical biopsies. The cost per ultrasonography-assessed woman was Euro 56.05, whereas the cost per additional mammographically occult but ultrasonography-detected cancer was Euro 146,496.53. The mammograms of the 2 cancer cases underwent blind review by an expert reader and were confirmed as negative.
Our findings show a low cancer detection rate, substantially lower compared to other clinical studies of ultrasonography in dense breasts, though in accordance with preliminary evidence from an Italian randomized clinical trial within a population-based screening program. The policy of adding ultrasonography to negative mammography in dense breasts seems to have very limited cost-effectiveness, and should not be adopted in routine practice before results of ongoing clinical trials are available.
评估乳腺超声检查在乳腺钼靶摄影显示为阴性的致密型乳腺中的补充作用。
在总共49044例连续的无症状女性乳腺钼靶摄影报告为阴性的病例中，25665例（52.3%）被编码为致密型（BI-RADS D3-4），并建议进行超声检查。由于组织问题，仅在5227例病例中立即或在1个月内进行了超声检查，这些病例构成了研究系列。
即时超声检查发现2例癌症（0.03%）。40-49岁和50-69岁女性的癌症检出率分别为0.002%和0.07%。粗针活检的良性活检率为0.5%，手术活检的良性活检率为0.02%。每位接受超声检查的女性的费用为56.05欧元，而每例额外的钼靶隐匿但超声检出的癌症的费用为146496.53欧元。2例癌症病例的乳腺钼靶片由一位专家读者进行了盲法评估，并确认为阴性。
我们的研究结果显示癌症检出率较低，与其他关于致密型乳腺超声检查的临床研究相比显著更低，不过与一项基于人群筛查项目的意大利随机临床试验的初步证据一致。在致密型乳腺中对钼靶摄影阴性的患者加做超声检查的策略似乎成本效益非常有限，在获得正在进行的临床试验结果之前不应在常规实践中采用。
