Department of Radiology, Massachusetts General Hospital, Boston, MA.
Department of Radiology, Massachusetts General Hospital, Boston, MA.
J Am Coll Surg. 2018 May;226(5):858-867. doi: 10.1016/j.jamcollsurg.2017.12.049. Epub 2018 Feb 2.
Our aim was to compare the pathologic upgrade rates of high-risk breast lesions (HRLs) on digital two-dimensional mammography (DM) vs digital breast tomosynthesis (DBT).
The study cohort was composed of patients with HRLs diagnosed by image-guided core needle biopsy from December 2007 to February 2011 (DM group, before DBT integration) and from January 2013 to March 2016 (DBT group, after complete DBT integration). Medical records were reviewed for surgical outcomes and follow-up imaging.
Eight hundred and ninety-three patients with 900 biopsy-proven HRLs underwent surgical excision (97.0% [873 of 900]) or had at least 2 years of imaging follow-up (3.0% [27 of 900]). The most common HRL was atypical ductal hyperplasia in the DM and DBT groups (37.4% [337 of 900]). The overall upgrade rate of HRLs to malignancy was 11.3% (102 of 900). There were no statistically significant differences in overall upgrades rates of HRLs on DM vs DBT (11.4% [54 of 475] vs 11.3% [48 of 425]; p = 0.97) or in upgrade rates of HRL subtypes. However, HRLs that upgraded on DBT were more likely to be invasive rather than in situ carcinoma compared with HRLs that upgraded on DM (39.6% [19 of 48] vs 20.4% [11 of 54]; p = 0.03). Overall, the most common HRL to upgrade was atypical ductal hyperplasia (18.4% [62 of 337]). The least common HRLs to upgrade in the DBT group were biphasic neoplasms (0% [0 of 22]), flat epithelial atypia (1.6% [1 of 62]), and papillomas without atypia (4.5% [2 of 44]).
There is no difference in the upgrade rates of HRLs on DM vs DBT, but the proportion of HRL upgrades that are invasive rather than in situ carcinoma is higher with DBT.
本研究旨在比较数字二维乳腺 X 线摄影（DM）与数字乳腺断层合成（DBT）对高危乳腺病变（HRL）的病理升级率。
研究队列由 2007 年 12 月至 2011 年 2 月（DM 组，在 DBT 整合之前）和 2013 年 1 月至 2016 年 3 月（DBT 组，在完全整合 DBT 之后）期间经影像引导下核心针活检诊断为 HRL 的患者组成。回顾了手术结果和随访影像学检查的病历。
893 例经活检证实的 900 例 HRL 患者行手术切除（97.0%[900 例中的 873 例]）或至少进行了 2 年的影像学随访（3.0%[900 例中的 27 例]）。最常见的 HRL 是 DM 和 DBT 组中的非典型导管增生（37.4%[900 例中的 337 例]）。HRL 整体恶变升级率为 11.3%（900 例中的 102 例）。DM 与 DBT 上 HRL 总体升级率无统计学差异（DM 组 11.4%[54 例中的 54 例]与 DBT 组 11.3%[48 例中的 48 例]；p=0.97）或 HRL 亚型的升级率无统计学差异。然而，与 DM 相比，在 DBT 上升级的 HRL 更有可能是浸润性而不是原位癌（39.6%[48 例中的 19 例]与 20.4%[54 例中的 11 例]；p=0.03）。总体而言，最常见的升级 HRL 是不典型导管增生（18.4%[337 例中的 62 例]）。在 DBT 组中，升级率最低的 HRL 是双相性肿瘤（0%[22 例中的 0 例]）、平坦上皮不典型（1.6%[62 例中的 1 例]）和无不典型的乳头瘤（4.5%[44 例中的 2 例]）。
DM 与 DBT 上 HRL 的升级率无差异，但 DBT 上 HRL 升级为浸润性癌的比例高于原位癌。
