Wang Wei-Shin, Hardesty Lara, Borgstede James, Takahashi Jayme, Sams Sharon
Academic Division, Department of Radiology, University of Colorado Denver School of Medicine, Aurora, Colorado.
Department of Radiology, Hawaii Permanente Medical Group, Honolulu, Hawaii.
Breast J. 2016 Nov;22(6):651-656. doi: 10.1111/tbj.12649.
To compare the pathology and histologic grading of breast cancers detected with digital breast tomosynthesis to those found with conventional digital mammography. The institutional review board approved this study. A database search for all breast cancers diagnosed from June 2012 through December 2013 was performed. Imaging records for these cancers were reviewed and patients who had screening mammography with tomosynthesis as their initial examination were selected. Five dedicated breast imaging radiologists reviewed each of these screening mammograms to determine whether the cancer was visible on conventional digital mammography or whether tomosynthesis was needed to identify the cancer. A cancer was considered mammographically occult if all five radiologists agreed that the cancer could not be seen on conventional digital mammography. The size, pathology and histologic grading for all diagnosed breast cancers were then reviewed. The Mann-Whitney U and Fisher exact tests were utilized to determine any association between imaging findings and cancer size, pathologic type and histologic grade. Sixty-five cancers in 63 patients were identified. Ten of these cancers were considered occult on conventional digital mammography and detected with the addition of tomosynthesis. These mammographically occult cancers were significantly associated with Nottingham grade 1 histologic pathology (p = 0.02), were smaller (median size: 6 mm versus 10 mm, p = 0.07) and none demonstrated axillary nodal metastases. Breast cancers identified through the addition of tomosynthesis are associated with Nottingham grade 1 histologic pathology and prognostically more favorable than cancers identified with conventional digital mammography alone.
比较数字乳腺断层合成术检测出的乳腺癌与传统数字乳腺摄影术检测出的乳腺癌的病理及组织学分级。机构审查委员会批准了本研究。对2012年6月至2013年12月期间诊断的所有乳腺癌进行数据库检索。回顾这些癌症的影像记录，选择以断层合成术作为初始检查进行乳腺筛查的患者。五名专业乳腺影像放射科医生对每一张乳腺筛查钼靶片进行审查，以确定癌症在传统数字乳腺摄影术中是否可见，或者是否需要断层合成术来识别癌症。如果所有五名放射科医生都认为在传统数字乳腺摄影术中看不到癌症，则该癌症被视为乳腺钼靶隐匿性癌症。然后回顾所有确诊乳腺癌的大小、病理及组织学分级。采用曼-惠特尼U检验和费舍尔精确检验来确定影像表现与癌症大小、病理类型及组织学分级之间的任何关联。共识别出63例患者中的65处癌症。其中10处癌症在传统数字乳腺摄影术中被视为隐匿性癌症，通过增加断层合成术检测到。这些乳腺钼靶隐匿性癌症与诺丁汉1级组织病理学显著相关（p = 0.02），体积较小（中位大小：6毫米对10毫米，p = 0.07），且均未显示腋窝淋巴结转移。通过增加断层合成术识别出的乳腺癌与诺丁汉1级组织病理学相关，并且在预后方面比仅通过传统数字乳腺摄影术识别出的癌症更有利。
