Bernardi Daniela, Belli Paolo, Benelli Eva, Brancato Beniamino, Bucchi Lauro, Calabrese Massimo, Carbonaro Luca A, Caumo Francesca, Cavallo-Marincola Beatrice, Clauser Paola, Fedato Chiara, Frigerio Alfonso, Galli Vania, Giordano Livia, Giorgi Rossi Paolo, Golinelli Paola, Morrone Doralba, Mariscotti Giovanna, Martincich Laura, Montemezzi Stefania, Naldoni Carlo, Paduos Adriana, Panizza Pietro, Pediconi Federica, Querci Fiammetta, Rizzo Antonio, Saguatti Gianni, Tagliafico Alberto, Trimboli Rubina M, Zappa Marco, Zuiani Chiara, Sardanelli Francesco
U.O. Senologia Clinica e Screening Mammografico, Dipartimento di Radiologia, APSS, Centro per i Servizi Sanitari, Pal. C, viale Verona, 38123, Trento, Italy.
Dipartimento di Scienze Radiologiche, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy.
Radiol Med. 2017 Oct;122(10):723-730. doi: 10.1007/s11547-017-0769-z. Epub 2017 May 25.
This position paper, issued by ICBR/SIRM and GISMa, summarizes the evidence on DBT and provides recommendations for its use. In the screening setting, DBT in adjunct to digital mammography (DM) increased detection rate by 0.5-2.7‰ and decreased false positives by 0.8-3.6% compared to DM alone in observational and double-testing experimental studies. The reduction in recall rate could be less prominent in those screening programs which already have low recall rates with DM. The increase in radiation exposure associated with DM/DBT protocols has been solved by the introduction of synthetic mammograms (sDM) reconstructed from DBT datasets. Thus, whenever possible, sDM/DBT should be preferred to DM/DBT. However, before introducing DBT as a routine screening tool for average-risk women, we should wait for the results of randomized controlled trials and for a statistically significant and clinically relevant reduction in the interval cancer rate, hopefully associated with a reduction in the advanced cancer rate. Otherwise, a potential for overdiagnosis and overtreatment cannot be excluded. Studies exploring this issue are ongoing. Screening of women at intermediate risk should follow the same recommendations, with particular protocols for women with previous BC history. In high-risk women, if mammography is performed as an adjunct to MRI or in the case of MRI contraindications, sDM/DBT protocols are suggested. Evidence exists in favor of DBT usage in women with clinical symptoms/signs and asymptomatic women with screen-detected findings recalled for work-up. The possibility to perform needle biopsy or localization under DBT guidance should be offered when DBT-only findings need characterization or surgery.
这份由ICBR/SIRM和GISMa发布的立场文件总结了数字化乳腺断层合成（DBT）的相关证据，并给出了其使用建议。在筛查方面，与单纯数字乳腺摄影（DM）相比，在观察性和双检测实验研究中，DBT辅助DM可使检出率提高0.5 - 2.7‰，假阳性率降低0.8 - 3.6%。在那些DM召回率已经较低的筛查项目中，召回率的降低可能不那么显著。通过引入从DBT数据集中重建的合成乳腺摄影（sDM），解决了与DM/DBT方案相关的辐射暴露增加问题。因此，只要有可能，应优先选择sDM/DBT而非DM/DBT。然而，在将DBT作为平均风险女性的常规筛查工具之前，我们应等待随机对照试验的结果，以及间期癌症率出现具有统计学意义和临床相关性的降低，希望同时晚期癌症率也能降低。否则，不能排除过度诊断和过度治疗的可能性。对此问题的研究正在进行中。对中度风险女性的筛查应遵循相同建议，对于有乳腺癌病史的女性有特定方案。在高风险女性中，如果乳腺摄影作为MRI的辅助检查或在MRI禁忌的情况下，建议采用sDM/DBT方案。有证据支持在有临床症状/体征的女性以及因进一步检查而召回的筛查发现无症状女性中使用DBT。当仅通过DBT发现需要进行特征描述或手术时，应提供在DBT引导下进行针吸活检或定位的可能性。
