1 Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, 1-10 Ami-Dong, Seo-gu, Busan 602-739, Republic of Korea.
2 Medical Research Institute, Pusan National University School of Medicine, Busan, Republic of Korea.
AJR Am J Roentgenol. 2017 Dec;209(6):1411-1418. doi: 10.2214/AJR.17.18195. Epub 2017 Aug 23.
The purpose of this study was to analyze the clinicopathologic and immunohistochemical features of invasive breast cancers detected only with digital breast tomosynthesis (DBT), compared with those of cancers detected with both DBT and full-field digital mammography (FFDM).
The medical records of 261 women (108 without and 153 with symptoms) with invasive breast cancers who underwent FFDM and DBT between April 2015 and June 2016 were retrospectively reviewed. To assess detectability, all DBT and FFDM images were reviewed independently by three radiologists blinded to clinicopathologic information. The reference standard was established by an unblinded consensus review of all images. Clinicopathologic and immunohistochemical features were analyzed according to the detectability status.
Of the 261 cancers, 223 (85.4%) were detected with both DBT and FFDM (both-detected group). Twenty-four cancers (9.2%) not detected with FFDM (DBT-only group) were classified by DBT as a mass (58.3%), architectural distortion (33.3%), or asymmetry (8.3%). The remaining 14 cancers (5.4%) were not detected with either DBT or FFDM (both-occult group). On multivariate analysis, a dense breast parenchyma (p = 0.007), small tumor size (≤ 2 cm; p = 0.027), and luminal A-like subtype (estrogen receptor positive or progesterone receptor positive or both, human epidermal growth factor receptor 2 negative, and Ki-67 expression < 14%; p = 0.008) were significantly associated with the DBT-only group. For 108 screening-detected cancers, a dense breast parenchyma (p = 0.007) and luminal A-like subtype (p = 0.008) also maintained significance.
The addition of DBT to FFDM in screening would aid in the detection of less-aggressive subtypes of invasive breast cancers in women with dense breasts.
本研究旨在分析仅通过数字乳腺断层摄影术（DBT）检测到的浸润性乳腺癌与通过 DBT 和全数字化乳腺摄影术（FFDM）检测到的浸润性乳腺癌的临床病理和免疫组化特征。
回顾性分析了 2015 年 4 月至 2016 年 6 月间接受 FFDM 和 DBT 检查的 261 例浸润性乳腺癌患者的病历资料（无症状 108 例，有症状 153 例）。为了评估可检测性，三位放射科医生独立对所有 DBT 和 FFDM 图像进行了回顾，且他们对临床病理信息均不知情。通过对所有图像进行非盲共识审查来建立参考标准。根据可检测性状态分析临床病理和免疫组化特征。
在 261 例癌症中，223 例（85.4%）通过 DBT 和 FFDM 均被检出（均检出组）。24 例（9.2%）FFDM 未检出的癌症（仅 DBT 检出组），根据 DBT 结果分类为肿块（58.3%）、结构扭曲（33.3%）或不对称（8.3%）。其余 14 例（5.4%）癌症既未通过 DBT 检出也未通过 FFDM 检出（均隐匿组）。多变量分析显示，致密乳腺实质（p = 0.007）、肿瘤较小（≤ 2cm；p = 0.027）和管腔 A 样亚型（雌激素受体阳性或孕激素受体阳性或两者均阳性，人表皮生长因子受体 2 阴性，Ki-67 表达＜14%；p = 0.008）与仅 DBT 检出组显著相关。对于 108 例筛查检出的癌症，致密乳腺实质（p = 0.007）和管腔 A 样亚型（p = 0.008）也具有显著意义。
在筛查中增加 DBT 可帮助检测致密乳腺中侵袭性较弱的乳腺癌亚型。
