在筛查环境下进行乳腺密度的自动容积分析：致密型乳腺女性的结局更差。
Automated Volumetric Analysis of Mammographic Density in a Screening Setting: Worse Outcomes for Women with Dense Breasts.
机构信息
From the Cancer Registry of Norway, Oslo, Norway (N.M., S.S., K.M.T., S.H.); Departments of Radiology (C.I.L.) and Medicine (J.G.E.), University of Washington School of Medicine, Seattle, Wash; Department of Clinical Medicine, Section for Pathology, Centre for Cancer Biomarkers (CCBIO), Bergen, Norway (L.A.A.); Department of Pathology, Haukeland University Hospital, Bergen, Norway (L.A.A.); and Oslo Metropolitan University, Faculty of Health Science, Oslo, Norway (S.H.).
出版信息
Radiology. 2018 Aug;288(2):343-352. doi: 10.1148/radiol.2018172972. Epub 2018 Jun 26.
Purpose To describe screening outcomes from BreastScreen Norway stratified by volumetric breast density (VBD). Materials and Methods This retrospective study included data from 107 949 women aged 50-69 years (mean age ± standard deviation, 58.7 years ± 5.6) who underwent 307 015 screening examinations from 2007 to 2015. Automated software classified mammographic density as nondense (VBD <7.5%) or dense (VBD ≥7.5%). Rates and distributions of screening outcomes (recall, biopsy, screen-detected and interval breast cancer, positive predictive values of recall and of needle biopsy, sensitivity, specificity, and histopathologic tumor characteristics) were analyzed and stratified by density. Tests of proportions, including propensity score and t tests, were used. Results In 28% (87 021 of 307 015) of the screening examinations, the breasts were classified as dense. Recall rates for women with nondense versus dense breasts were 2.7% (5882 of 219 994) and 3.6% (3101 of 87 021); biopsy rates were 1.1% (2359 of 219 994) and 1.4% (1209 of 87 021); rates of screen-detected cancer were 5.5 (1210 of 219 994) and 6.7 (581 of 87 021) per 1000 examinations; and rates of interval breast cancer were 1.2 (199 of 165 324) and 2.8 (185 of 66 674) per 1000 examinations, respectively (P < .001 for all). Sensitivity was 82% (884 of 1083) for nondense breasts and 71% (449 of 634) for dense breasts, whereas specificity was 98% (160 973 of 164 440) and 97% (64 250 of 66 225), respectively (P < .001 for both). For screen-detected cancers, mean tumor diameter was 15.1 mm and 16.6 mm (P = .01), and lymph node-positive disease was found in 18% (170 of 936) and 24% (98 of 417) (P = .02) of women with nondense and dense breasts, respectively. Conclusion Screening examinations of women with dense breasts classified by using automated software resulted in higher recall rate, lower sensitivity, larger tumor diameter, and more lymph node-positive disease compared with women with nondense breasts.
目的
描述挪威乳腺筛查中基于体积乳腺密度（VBD）的筛查结果。
材料与方法
本回顾性研究纳入了 2007 年至 2015 年间年龄在 50-69 岁（平均年龄±标准差，58.7 岁±5.6 岁）的 107949 名女性的资料，这些女性共接受了 307015 次筛查检查。自动化软件将乳腺密度分类为非致密型（VBD<7.5%）或致密型（VBD≥7.5%）。分析并分层比较了不同密度组的筛查结果（召回、活检、筛查发现和间隔期乳腺癌、召回和针吸活检的阳性预测值、敏感性、特异性和组织病理学肿瘤特征）。采用比例检验（包括倾向评分和 t 检验）。
结果
在 307015 次筛查检查中，28%（87021 例）的乳房被归类为致密型。非致密型和致密型乳房的召回率分别为 2.7%（5882 例/21994 例）和 3.6%（3101 例/87021 例）；活检率分别为 1.1%（2359 例/21994 例）和 1.4%（1209 例/87021 例）；筛查发现癌症的发生率分别为 5.5/1000 次检查（1210 例/21994 例）和 6.7/1000 次检查（581 例/87021 例）；间隔期乳腺癌的发生率分别为 1.2/1000 次检查（199 例/165324 例）和 2.8/1000 次检查（185 例/66674 例），差异均具有统计学意义（均 P<0.001）。非致密型乳房的敏感性为 82%（884 例/1083 例），致密型乳房的敏感性为 71%（449 例/634 例），而非致密型乳房的特异性为 98%（160973 例/164440 例），致密型乳房的特异性为 97%（64250 例/66225 例），差异均具有统计学意义（均 P<0.001）。对于筛查发现的癌症，肿瘤平均直径分别为 15.1 毫米和 16.6 毫米（P=0.01），非致密型和致密型乳房的淋巴结阳性疾病发生率分别为 18%（170 例/936 例）和 24%（98 例/417 例）（P=0.02）。
结论
与非致密型乳房相比，使用自动化软件对致密型乳房进行分类的筛查检查导致更高的召回率、更低的敏感性、更大的肿瘤直径和更多的淋巴结阳性疾病。
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