Timmermans Lore, Bleyen Luc, Bacher Klaus, Van Herck Koen, Lemmens Kim, Van Ongeval Chantal, Van Steen Andre, Martens Patrick, De Brabander Isabel, Goossens Mathieu, Thierens Hubert
Department of Basic Medical Sciences, QCC-Gent, Ghent University, Ghent, Belgium.
Centrum voor Preventie en Vroegtijdige Opsporing van Kanker, Ghent University, Ghent, Belgium.
Eur Radiol. 2017 Sep;27(9):3810-3819. doi: 10.1007/s00330-017-4757-4. Epub 2017 Mar 13.
To investigate if direct radiography (DR) performs better than screen-film mammography (SF) and computed radiography (CR) in dense breasts in a decentralized organised Breast Cancer Screening Programme. To this end, screen-detected versus interval cancers were studied in different BI-RADS density classes for these imaging modalities.
The study cohort consisted of 351,532 women who participated in the Flemish Breast Cancer Screening Programme in 2009 and 2010. Information on screen-detected and interval cancers, breast density scores of radiologist second readers, and imaging modality was obtained by linkage of the databases of the Centre of Cancer Detection and the Belgian Cancer Registry.
Overall, 67% of occurring breast cancers are screen detected and 33% are interval cancers, with DR performing better than SF and CR. The interval cancer rate increases gradually with breast density, regardless of modality. In the high-density class, the interval cancer rate exceeds the cancer detection rate for SF and CR, but not for DR.
DR is superior to SF and CR with respect to cancer detection rates for high-density breasts. To reduce the high interval cancer rate in dense breasts, use of an additional imaging technique in screening can be taken into consideration.
• Interval cancer rate increases gradually with breast density, regardless of modality. • Cancer detection rate in high-density breasts is superior in DR. • IC rate exceeds CDR for SF and CR in high-density breasts. • DR performs better in high-density breasts for third readings and false-positives.
在一个去中心化组织的乳腺癌筛查项目中，研究直接数字化X线摄影（DR）在致密型乳腺中是否比屏-片乳腺摄影（SF）和计算机X线摄影（CR）表现更好。为此，针对这些成像方式，在不同的乳腺影像报告和数据系统（BI-RADS）密度类别中研究筛查发现的癌症与间期癌。
研究队列由2009年和2010年参加弗拉芒乳腺癌筛查项目的351,532名女性组成。通过癌症检测中心和比利时癌症登记处的数据库链接，获取筛查发现的和间期癌的信息、放射科二级阅片医生的乳腺密度评分以及成像方式。
总体而言，67%的发生的乳腺癌是筛查发现的，33%是间期癌，DR的表现优于SF和CR。无论采用何种方式，间期癌发生率均随乳腺密度逐渐增加。在高密度类别中，SF和CR的间期癌发生率超过癌症检出率，但DR并非如此。
在高密度乳腺的癌症检出率方面，DR优于SF和CR。为降低致密型乳腺的高间期癌发生率，可考虑在筛查中使用额外的成像技术。
• 无论采用何种方式，间期癌发生率均随乳腺密度逐渐增加。• DR在高密度乳腺中的癌症检出率更高。• 在高密度乳腺中，SF和CR的IC率超过CDR。• DR在高密度乳腺的第三次阅片和假阳性方面表现更好。
