数字乳腺 X 线摄影是否会增加对表现为钙化的高危乳腺病变的检出率？

Does digital mammography increase detection of high-risk breast lesions presenting as calcifications?

机构信息

1 Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Med Inn Bldg C415, SPC 5842, Ann Arbor, MI 48109-4852.

出版信息

AJR Am J Roentgenol. 2013 Nov;201(5):1148-54. doi: 10.2214/AJR.12.10195.

DOI:10.2214/AJR.12.10195

PMID:24147490

Abstract

OBJECTIVE

The objective of our study was to evaluate whether the transition from film-screen mammography (FSM) to digital mammography (DM) was associated with increased detection of high-risk breast lesions.

MATERIALS AND METHODS

A retrospective search identified 142 cases of atypia or lobular neoplasia (LN) diagnosed in women with mammographic calcifications between January 2004 and August 2010. We excluded lesions upgraded to cancer at excisional biopsy, lesions in women with ipsilateral cancer within 2 years of mammography, and lesions that presented as a mass only. The cases included in the cohort were 82 (57.7%) cases of atypical ductal hyperplasia; 17 (12%) atypical lobular hyperplasia; 25 (17.6%) lobular carcinoma in situ (LCIS); 12 (8.5%) atypia and LCIS; and six (4.2%) other atypia. The institution transitioned from predominantly performing FSM in 2004 to performing only DM by 2010. Pathology was interpreted by breast pathologists. The annual detection rate was calculated by dividing the number of high-risk lesions by mammography volume.

RESULTS

Of the 142 cases of atypia or LN, 52 (36.6%) were detected using FSM and 90 (63.4%) were detected using DM. The detection rate was higher with DM (1.24/1000 mammographic studies) than FSM (0.37/1000 mammographic studies). The detection rate by year ranged between 0.21 and 0.64 per 1000 mammographic studies for FSM and between 0.32 and 1.49 per 1000 mammographic studies for DM. The median size of the calcifications was 8 mm on DM and 7 mm on FSM. The most common appearance was clustered amorphous or indistinct calcifications on both FSM and DM.

CONCLUSION

The transition from FSM to DM was associated with a threefold increase in the detection rate of high-risk lesions. Improved detection may allow enhanced screening, risk reduction treatment, and possibly breast cancer prevention. However, increased detection of high-risk lesions may also result in oversurveillance and treatment.

摘要

目的

本研究旨在评估从屏片式乳腺摄影（FSM）向数字乳腺摄影（DM）过渡是否与高危乳腺病变的检出率增加有关。

材料和方法

回顾性搜索确定了 2004 年 1 月至 2010 年 8 月期间患有乳腺钙化的女性中诊断为非典型性或小叶肿瘤（LN）的 142 例病例。我们排除了在切除活检中升级为癌症的病变、在乳腺摄影后 2 年内同侧患有癌症的女性的病变以及仅表现为肿块的病变。该队列中包括 82 例（57.7%）非典型导管增生；17 例（12%）非典型小叶增生；25 例（17.6%）小叶原位癌（LCIS）；12 例（8.5%）非典型性和 LCIS；和 6 例（4.2%）其他非典型性病变。该机构于 2004 年主要进行 FSM，到 2010 年已过渡到仅进行 DM。病理学由乳腺病理学家解释。通过用高危病变数量除以乳腺摄影量来计算年度检出率。

结果

在 142 例非典型性或 LN 病例中，52 例（36.6%）使用 FSM 检出，90 例（63.4%）使用 DM 检出。DM 的检出率（1.24/1000 次乳腺摄影研究）高于 FSM（0.37/1000 次乳腺摄影研究）。FSM 的年度检出率范围为 0.21 至 0.64/1000 次乳腺摄影研究，DM 的年度检出率范围为 0.32 至 1.49/1000 次乳腺摄影研究。DM 上钙化的中位数大小为 8mm，FSM 上为 7mm。最常见的表现是在 FSM 和 DM 上均为簇状不透明或模糊的钙化。