Department of Clinical Radiology and Reference Center for Mammography, University Hospital Muenster, Albert-Schweitzer-Strasse 33, 48149 Muenster, Germany.
Radiology. 2010 Jun;255(3):738-45. doi: 10.1148/radiol.10091173.
To evaluate the relevance of calcifications for invasive breast cancer detection in population-based digital mammographic screening.
This study was approved by an independent ethics committee, and no additional informed consent was required. Prospectively documented radiologic cancer features were correlated with pathologic characteristics in 241 breast malignancies diagnosed in 24067 participating women aged 50-69 years (part of the digital German Screening Program; initial screening rate, 92%; detection rate [DR], 1.0%; recall rate [RR], 7.5%). The rates of invasive cancers detected on the basis of calcifications were analyzed against pathologic tumor categories (pT categories) and histologic grades. For comparison of the study data with results of analog screening, data from the literature regarding calcification-specific RR, DR, and positive predictive value for recall (PPV(1)) were calculated.
The calcification-specific RR was 1.7% (416 of 24067). The calcification-specific DR for invasive cancer was 0.12% (29 of 24067), and the PPV(1) was 7.0% (29 of 416). Of all malignancies detected on the basis of calcification, 38% (29 of 77) were invasive. pT1 cancers showed an inverse association between tumor size and rate of detection on the basis of calcification; differences in rates among pT1 subcategories were statistically significant (P < .001). The proportion of grade 1 pT1 cancers detected on the basis of calcification (eight of 27) did not differ significantly from that of cancers detected on the basis of other radiologic features (46 of 108, P = .24). The calcification-specific invasive cancer DR was significantly higher for digital than for analog mammography.
One-third of malignancies detected on the basis of calcifications only are invasive cancers. They tend to be smaller but not less aggressive than invasive cancers detected on the basis of other features. Compared with published results of analog screening, digital screening offers the potential to increase the rate of invasive cancers detected on the basis of calcifications in population-based mammographic screening.
评估人群基础数字化乳腺筛查中钙化对浸润性乳腺癌检出的相关性。
本研究经独立伦理委员会批准，无需额外签署知情同意书。对 24067 例年龄 50-69 岁的参试女性（数字化德国筛查项目的一部分；初始筛查率为 92%；检出率[DR]为 1.0%；召回率[RR]为 7.5%）前瞻性记录的放射学癌症特征与病理学特征进行相关性分析。基于钙化检出的浸润性癌症检出率与病理学肿瘤分期（pT 分期）和组织学分级进行分析。为了将本研究数据与模拟筛查结果进行比较，计算了文献中关于钙化特异性 RR、DR 和召回阳性预测值（PPV(1)）的相关数据。
钙化特异性 RR 为 1.7%（416/24067）。基于钙化检出的浸润性癌症 DR 为 0.12%（29/24067），PPV(1)为 7.0%（29/416）。基于钙化检出的所有恶性肿瘤中，38%（29/77）为浸润性。pT1 癌症的肿瘤大小与基于钙化检出率之间呈反比关系；pT1 亚分期之间的检出率差异具有统计学意义（P<0.001）。基于钙化检出的 pT1 分级 1 癌症（27 例中有 8 例）的比例与基于其他放射学特征检出的癌症（108 例中有 46 例）无显著差异（P=0.24）。基于钙化检出的浸润性癌症 DR 数字筛查明显高于模拟筛查。
仅基于钙化检出的恶性肿瘤中，有三分之一为浸润性癌症。与基于其他特征检出的癌症相比，它们倾向于更小但侵袭性并不低。与模拟筛查的已发表结果相比，数字化筛查有可能提高人群基础乳腺筛查中基于钙化检出的浸润性癌症检出率。
