1 ARCADES Association pour la Recherche et le Dépistage des Cancers du Sein, du Col de l'Utérus et des Cancers Colorectaux. Parc Mure, 16 Blvd des Aciéries, 13395 Marseille Cedex 10, France.
AJR Am J Roentgenol. 2014 Jan;202(1):229-36. doi: 10.2214/AJR.12.10419.
The purpose of this article was to compare the performance of digital mammography using hardcopy image reading against film-screen mammography in a French national routine population-based screening program with a decentralized organization. The French context offered the opportunity to examine separately computed radiography and direct digital mammography performances in a large cohort.
The study includes 23,423 direct digital mammography, 73,320 computed radiography, and 65,514 film-screen mammography examinations performed by 123 facilities in Bouches du Rhône, France, for women 50-74 years old between 2008 and 2010. We compared abnormal mammography findings rate, cancer detection rate, and tumor characteristics among the technologies.
Abnormal finding rates were higher for direct digital mammography (7.78% vs 6.11% for film-screen mammography and 5.34% for computed radiography), particularly in younger women and in denser breasts. Cancer detection rates were also higher for direct digital mammography (0.71% vs 0.66% for film-screen mammography and 0.55% for computed radiography). The contrast between detection rates was stronger for ductal carcinoma in situ. Breast density was the main factor explaining the differences in detection rates. For direct digital mammography only, the detection rate was clearly higher in dense breasts whatever the age (odds ratio, 2.20). Except for grade, no differences were recorded concerning tumor characteristics in which the proportion of high-grade tumors was larger for direct digital mammography for invasive and in situ tumors.
Direct digital mammography has a higher detection rate than film-screen mammography in dense breasts and for tumors of high grade. This latter association warrants further study to measure the impact of technology on efficacy of screening. The data indicate that computed radiography detects fewer tumors than film-screen mammography in most instances.
本研究旨在比较数字乳腺摄影术（硬拷贝图像阅读）与传统屏片乳腺摄影术在法国全国基于人群的常规筛查计划中的表现，该计划采用分散式组织方式。法国的背景为我们提供了机会，能够在一个大型队列中分别检查计算机射线摄影术和直接数字乳腺摄影术的性能。
本研究包括 2008 年至 2010 年间，法国布克多尔（Bouches du Rhône）地区的 123 家医疗机构为 50-74 岁女性进行的 23423 例直接数字乳腺摄影术、73320 例计算机射线摄影术和 65514 例屏片乳腺摄影术检查。我们比较了这些技术之间的异常乳腺检查结果率、癌症检出率和肿瘤特征。
直接数字乳腺摄影术的异常发现率更高（7.78%比屏片乳腺摄影术的 6.11%和计算机射线摄影术的 5.34%），尤其是在年轻女性和致密乳腺中。直接数字乳腺摄影术的癌症检出率也更高（0.71%比屏片乳腺摄影术的 0.66%和计算机射线摄影术的 0.55%）。导管原位癌的检测率差异更为明显。乳腺密度是解释检出率差异的主要因素。仅就直接数字乳腺摄影术而言，无论年龄大小，致密乳腺的检出率明显更高（比值比，2.20）。除分级外，在肿瘤特征方面没有记录到差异，其中直接数字乳腺摄影术的浸润性和原位肿瘤中高级别肿瘤的比例更大。
在致密乳腺和高级别肿瘤中，直接数字乳腺摄影术的检出率高于屏片乳腺摄影术。后一种关联需要进一步研究，以衡量技术对筛查效果的影响。数据表明，在大多数情况下，计算机射线摄影术比屏片乳腺摄影术检出的肿瘤更少。
