National Expert and Training Centre for Breast Cancer Screening, PO Box 6873, 6503 GJ Nijmegen, the Netherlands.
Radiology. 2012 Dec;265(3):707-14. doi: 10.1148/radiol.12111461. Epub 2012 Oct 2.
To compare screen-film mammography with digital mammography in a breast cancer screening program, with a focus on the clinical relevance of detected cancers.
The study was approved by the regional medical ethics review board. Informed consent was not required. Before the nationwide transition to digital mammography in the Dutch biennial screening program, the performance of digital mammography was studied in three screening regions. For initial screening examinations, mediolateral oblique and craniocaudal views were obtained of each breast. In subsequent examinations, the mediolateral oblique view was standard. A craniocaudal view was added if indicated. Screening outcomes obtained with screen-film mammography and digital mammography, including radiologic and pathologic characteristics, were compared for initial and subsequent examinations.
A total of 1,198,493 screening examinations were performed between 2003 and 2007. Recall was indicated in 18 896 cases (screen-film mammography: 2.6% at initial examinations, 1.3% at subsequent examinations; digital mammography: 4.4% at initial examinations, 2.1% at subsequent examinations; P < .001 for both). Breast cancer was diagnosed in 6410 women (detection rate per 1000 women with screen-film mammography: 5.6 at initial examinations, 5.2 at subsequent examinations; detection rate per 1000 women with digital mammography: 6.8 at initial examinations, 6.1 at subsequent examinations; P = .02 and P < .001, respectively). Digital mammography depicted significantly more ductal carcinoma in situ (DCIS) lesions, irrespective of screening round. Invasive carcinoma was detected significantly more often in subsequent examinations, particularly when associated with microcalcifications (P = .047). The distribution of the histopathologic differentiation grades for DCIS and invasive carcinoma were similar with both modalities. However, with digital mammography more high-grade DCIS lesions were detected at subsequent examinations (P = .013).
In a population-based breast screening program, the performance of digital mammography in the detection of DCIS and invasive carcinoma was substantially better than that of screen-film mammography. There is no sign of an increase in detection of low-grade DCIS lesions-indicative of possible overdiagnosis-with digital breast cancer screening. Rather, digital mammography appears to add to the detection of high-grade DCIS.
在乳腺癌筛查项目中比较屏片乳腺摄影与数字乳腺摄影，重点关注检出癌症的临床相关性。
本研究经地区医学伦理审查委员会批准，无需获得患者知情同意。在荷兰每两年一次的筛查项目中全面转向数字乳腺摄影之前，在三个筛查区域研究了数字乳腺摄影的性能。对于初始筛查检查，对每只乳房进行侧斜位和头尾位投照。在后续检查中，标准投照位为侧斜位。如果需要，加照头尾位。比较屏片乳腺摄影和数字乳腺摄影的筛查结果，包括影像学和病理学特征，用于初始和后续检查。
2003 年至 2007 年期间共进行了 1198493 次筛查检查。在初始检查中，有 18896 例（屏片乳腺摄影：2.6%；数字乳腺摄影：4.4%）需要召回，在后续检查中，有 13%（屏片乳腺摄影：1.3%；数字乳腺摄影：2.1%）需要召回（两者均 P <.001）。在 6410 名女性中诊断出乳腺癌（屏片乳腺摄影：初始检查每 1000 名女性中检出率为 5.6 例，后续检查为 5.2 例；数字乳腺摄影：初始检查每 1000 名女性中检出率为 6.8 例，后续检查为 6.1 例；P =.02 和 P <.001）。数字乳腺摄影显示出更多的导管原位癌（DCIS）病变，而与筛查轮次无关。在后续检查中，浸润性癌的检出率显著更高，尤其是当伴有微钙化时（P =.047）。DCIS 和浸润性癌的组织病理学分化程度分布在两种模式下相似。然而，数字乳腺摄影在后续检查中发现更多高级别的 DCIS 病变（P =.013）。
在基于人群的乳腺癌筛查项目中，数字乳腺摄影在检测 DCIS 和浸润性癌方面的性能明显优于屏片乳腺摄影。数字乳腺癌筛查并没有显示出低级别 DCIS 病变检出率增加的迹象，这可能表明存在过度诊断。相反，数字乳腺摄影似乎增加了高级别 DCIS 的检出率。
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