Departments of Surgery and Radiology, University of Vermont Cancer Center, University of Vermont, Burlington, VT.
Departments of Medicine and Epidemiology and Biostatistics and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA.
J Natl Cancer Inst. 2019 Jun 1;111(6):629-632. doi: 10.1093/jnci/djy210.
Changes to mammography practice, including revised Breast Imaging Reporting and Data System (BI-RADS) density classification guidelines and implementation of digital breast tomosynthesis (DBT), may impact clinical breast density assessment. We investigated temporal trends in clinical breast density assessment among 2 990 291 digital mammography (DM) screens and 221 063 DBT screens interpreted by 722 radiologists from 144 facilities in the Breast Cancer Surveillance Consortium. After age-standardization, 46.3% (95% CI = 44.1% to 48.6%) of DM screens were assessed as dense (heterogeneously/extremely dense) during the BI-RADS 4th edition era (2005-2013), compared to 46.5% (95% CI = 43.8% to 49.1%) during the 5th edition era (2014-2016) (P = .93 from two-sided generalized score test). Among DBT screens in the BI-RADS 5th edition era, 45.8% (95% CI = 42.0% to 49.7%) were assessed as dense (P = .77 from two-sided generalized score test) compared to 46.5% (95% CI = 43.8% to 49.1%) dense on DM in BI-RADS 5th edition era. Results were similar when examining all four density categories and age subgroups. Clinicians, researchers, and policymakers may reasonably expect stable density distributions across screened populations despite changes to the BI-RADS guidelines and implementation of DBT.
在乳腺摄影实践中发生的变化，包括修订后的乳腺影像报告和数据系统（BI-RADS）密度分类指南和数字乳腺断层合成术（DBT）的实施，可能会影响临床乳腺密度评估。我们调查了 2990291 例数字乳腺摄影（DM）筛查和 221063 例 DBT 筛查中临床乳腺密度评估的时间趋势，这些筛查由来自 144 个设施的 722 名放射科医生进行解释，这些筛查来自乳腺肿瘤监测联盟。在年龄标准化后，在 BI-RADS 第 4 版时代（2005-2013 年），46.3%（95%CI=44.1%至 48.6%）的 DM 筛查被评估为致密（异质性/极度致密），而在 BI-RADS 第 5 版时代（2014-2016 年）为 46.5%（95%CI=43.8%至 49.1%）（双侧广义得分检验 P=0.93）。在 BI-RADS 第 5 版时代的 DBT 筛查中，45.8%（95%CI=42.0%至 49.7%）被评估为致密（双侧广义得分检验 P=0.77），而在 BI-RADS 第 5 版时代的 DM 中，46.5%（95%CI=43.8%至 49.1%）被评估为致密。当检查所有四个密度类别和年龄亚组时，结果相似。尽管 BI-RADS 指南发生变化并实施了 DBT，但临床医生、研究人员和政策制定者可能会合理地期望在筛查人群中保持稳定的密度分布。
