Department of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
Department of Breast Imaging, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
Clin Breast Cancer. 2018 Jun;18(3):e353-e361. doi: 10.1016/j.clbc.2017.07.014. Epub 2017 Aug 15.
Until now, no studies have investigated whether women other than those with dense breasts are suitable for adjunctive ultrasonography after negative mammography, and investigated whether all women with negative mammography are suitable for adjunctive ultrasonography.
Based on the Multi-modality Independent Screening Trial in China, a total of 31,918 women aged 45 to 65 years underwent both ultrasonography and mammography. Physicians performed ultrasonography and mammography separately and were blinded to each other's findings until their interpretations had been recorded. For both ultrasonography and mammography, suspicious results and those highly suggestive of a malignancy were confirmed by pathologic examination, whereas other results were confirmed by 1-year follow-up after initial screening.
Based on Breast Imaging Reporting and Data System (BIRADS) assessments, 84 (84.8%) of 99 cancers were identified on mammography (detection rate, 2.6/1000), and 61 (61.6%) of 99 cancers were identified on ultrasonography (detection rate, 1.9/1000). Integrated mammography with ultrasonography identified 94 (95.0%) of 99 cancers, with an increment of 11.9% in cancer detection rate (from 2.6/1000 to 2.9/1000) (P < .05). Moreover, among women with BIRADS 3, adjunctive ultrasonography detected no cancers. All 10 additional cancers detected by adjunctive ultrasonography were from women with BIRADS 0 to 2, at a cost of 207 women with false positives. Additionally, dense breasts and benign breast disease were significantly associated with positive ultrasonography after BIRADS 0 to 2 (all P values < .05).
After negative mammography, adjunctive ultrasonography should only be recommended for BIRADS 0 to 2 but not BIRADS 3, especially for women with dense breasts or benign breast disease.
到目前为止，还没有研究调查非致密性乳腺的女性在阴性乳腺 X 线摄影后是否适合附加超声检查，也没有研究调查所有阴性乳腺 X 线摄影的女性是否都适合附加超声检查。
基于中国多模态独立筛查试验，共有 31918 名 45 至 65 岁的女性接受了超声和乳腺 X 线摄影检查。医生分别进行超声和乳腺 X 线摄影检查，在记录各自的检查结果之前，彼此之间的检查结果是互不知情的。对于超声和乳腺 X 线摄影检查，可疑结果和高度提示恶性的结果通过病理检查确认，而其他结果则通过初始筛查后 1 年的随访确认。
基于乳腺影像报告和数据系统（BIRADS）评估，99 例癌症中有 84 例（84.8%）在乳腺 X 线摄影中检出（检出率为 2.6/1000），99 例癌症中有 61 例（61.6%）在超声中检出（检出率为 1.9/1000）。综合乳腺 X 线摄影和超声检查共检出 99 例癌症中的 94 例（95.0%），癌症检出率增加了 11.9%（从 2.6/1000 增加到 2.9/1000）（P<0.05）。此外，在 BIRADS 3 的女性中，附加超声检查未检出癌症。附加超声检查检出的 10 例额外癌症均来自 BIRADS 0 至 2 的女性，假阳性病例为 207 例。此外，致密乳腺和良性乳腺疾病与 BIRADS 0 至 2 后的阳性超声检查显著相关（所有 P 值均<0.05）。
在阴性乳腺 X 线摄影后，仅建议对 BIRADS 0 至 2 进行附加超声检查，而不建议对 BIRADS 3 进行附加超声检查，尤其是对于致密乳腺或良性乳腺疾病的女性。
