Winkel Rikke Rass, Euler-Chelpin My von, Lynge Elsebeth, Diao Pengfei, Lillholm Martin, Kallenberg Michiel, Forman Julie Lyng, Nielsen Michael Bachmann, Uldall Wei Yao, Nielsen Mads, Vejborg Ilse
Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark.
Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1014, Copenhagen K, Denmark.
Cancer Epidemiol. 2017 Aug;49:53-60. doi: 10.1016/j.canep.2017.05.006. Epub 2017 May 27.
The long-term risk of breast cancer is increased in women with false-positive (FP) mammography screening results. We investigated whether mammographic morphology and/or density can be used to stratify these women according to their risk of future breast cancer METHODS: We undertook a case-control study nested in the population-based screening programme in Copenhagen, Denmark. We included 288 cases and 288 controls based on a cohort of 4743 women with at least one FP-test result in 1991-2005 who were followed up until 17 April 2008. Film-based mammograms were assessed using the Breast Imaging-Reporting and Data System (BI-RADS) density classification, the Tabár classification, and two automated techniques quantifying percentage mammographic density (PMD) and mammographic texture (MTR), respectively. The association with breast cancer was estimated using binary logistic regression calculating Odds Ratios (ORs) and the area under the receiver operating characteristic (ROC) curves (AUCs) adjusted for birth year and age and invitation round at the FP-screen RESULTS: Significantly increased ORs were seen for BI-RADS D(density)2-D4 (OR 1.94; 1.30-2.91, 2.36; 1.51-3.70 and 4.01; 1.67-9.62, respectively), Tabár's P(pattern)IV (OR 1.83; 1.16-2.89), PMD Q(quartile)2-Q4 (OR 1.71; 1.02-2.88, 1.97; 1.16-3.35 and 2.43; 1.41-4.19, respectively) and MTR Q4 (1.97; 1.12-3.46) using the lowest/fattiest category as reference CONCLUSION: All four methods, capturing either mammographic morphology or density, could segregate women with FP-screening results according to their risk of future breast cancer - using already available screening mammograms. Our findings need validation on digital mammograms, but may inform potential future risk stratification and tailored screening strategies.
乳腺钼靶筛查结果为假阳性（FP）的女性患乳腺癌的长期风险会增加。我们调查了乳腺钼靶形态和/或密度是否可用于根据这些女性未来患乳腺癌的风险进行分层。方法：我们在丹麦哥本哈根基于人群的筛查项目中进行了一项病例对照研究。我们纳入了288例病例和288例对照，这些病例和对照来自于1991年至2005年期间至少有一次FP检测结果且随访至2008年4月17日的4743名女性队列。基于胶片的乳腺钼靶片使用乳腺影像报告和数据系统（BI-RADS）密度分类、塔巴尔分类以及两种分别量化乳腺钼靶密度百分比（PMD）和乳腺钼靶纹理（MTR）的自动化技术进行评估。使用二元逻辑回归计算优势比（OR）以及根据出生年份、年龄和FP筛查时的邀请轮次进行调整的受试者操作特征（ROC）曲线下面积（AUC）来估计与乳腺癌的关联。结果：以最低/最致密类别为参照，BI-RADS D（密度）2-D4（OR分别为1.94；1.30-2.91、2.36；1.51-3.70和4.01；1.67-9.62）、塔巴尔的P（模式）IV（OR 1.83；1.16-2.89）、PMD Q（四分位数）2-Q4（OR分别为1.71；1.02-2.88、1.97；1.16-3.35和2.43；1.41-4.19）以及MTR Q4（1.97；1.12-3.46）的OR值显著升高。结论：所有这四种方法，无论是捕捉乳腺钼靶形态还是密度，都可以根据未来患乳腺癌风险对有FP筛查结果的女性进行分层——利用现有的筛查乳腺钼靶片。我们的研究结果需要在数字乳腺钼靶片上进行验证，但可能为未来潜在的风险分层和个性化筛查策略提供参考。
