Weigert Jean, Steenbergen Sarah
Mandell and Blau MD's PC, New Britain, Connecticut.
Breast J. 2015 Mar-Apr;21(2):175-80. doi: 10.1111/tbj.12386. Epub 2015 Feb 16.
To determine if the addition of screening breast ultrasound in women with mammographically normal but dense breasts improves breast cancer detection. The study utilized a retrospective chart review. Data collected included: (a) total number of screening mammograms; (b) total number of dense breast screening ultrasounds; (c) screening ultrasound Breast Imaging Reporting Data System (BI-RADS) code results; (d) biopsy results; and (e) demographic data on women with malignant biopsies. Data were obtained from sites throughout Connecticut from November 1, 2010 to October 31, 2011. Data from 5 Connecticut radiology practices covering 10 sites were collected. Sites conducted a total of 57,417 screening mammograms and 10,282 dense breast screening ultrasounds. Of the screening ultrasounds, 87% (8,972/10,282) were BI-RADS 1 or 2, 9% (875/10,282) were BI-RADS 3, 4% (435/10,282) were BI-RADS 4 or 5, and 39 were found to have a cancer or high-risk lesion on biopsy. This correlates to 3.8 cancers or high-risk lesions per 1,000 women screened. If high-risk lesions are excluded, there are 24 cases of biopsy proven malignancy corresponding to 2.3 cancers per 1,000 women screened. In this study, screening breast ultrasound in women with mammographically normal but dense breasts demonstrated a positive predictive value of 9% (39/435) and specificity of 96% (8,972/9,368). Based on the data collected from sites throughout Connecticut, screening breast ultrasound in women with dense breast parenchyma detects mammographically occult malignancy and high-risk lesions. The results are especially significant given recent studies suggesting that breast density is an independent risk factor for breast cancer and that mammography is less effective in detecting cancer in dense breasts. The improved specificity and sensitivity between the 1st and 2nd years' suggests there is a learning curve that may continue to improve the results.
为了确定在乳房X线摄影检查正常但乳房致密的女性中增加乳腺超声筛查是否能提高乳腺癌的检出率。该研究采用回顾性病历审查。收集的数据包括：（a）乳腺筛查乳房X线摄影检查的总数；（b）致密乳腺筛查超声的总数；（c）筛查超声乳腺影像报告和数据系统（BI-RADS）编码结果；（d）活检结果；以及（e）恶性活检女性的人口统计学数据。数据于2010年11月1日至2011年10月31日从康涅狄格州各地的机构获取。收集了来自康涅狄格州5个放射学实践机构涵盖10个地点的数据。这些地点共进行了57,417次乳腺筛查乳房X线摄影检查和10,282次致密乳腺筛查超声检查。在筛查超声检查中，87%（8,972/10,282）为BI-RADS 1或2级，9%（875/10,282）为BI-RADS 3级，4%（435/10,282）为BI-RADS 4或5级，并且在活检中发现39例患有癌症或高危病变。这相当于每1000名接受筛查的女性中有3.8例癌症或高危病变。如果排除高危病变，则有24例活检证实为恶性肿瘤，相当于每1000名接受筛查的女性中有2.3例癌症。在本研究中，对乳房X线摄影检查正常但乳房致密的女性进行乳腺超声筛查，其阳性预测值为9%（39/435），特异性为96%（8,972/9,368）。基于从康涅狄格州各地机构收集的数据，对乳腺实质致密的女性进行乳腺超声筛查可检测出乳房X线摄影检查隐匿的恶性肿瘤和高危病变。鉴于最近的研究表明乳腺密度是乳腺癌的独立危险因素，且乳房X线摄影检查在检测致密乳房中的癌症效果较差，这些结果尤为显著。第一年和第二年之间提高的特异性和敏感性表明存在学习曲线，可能会继续改善结果。
