1 Department of Surgery, University of Vermont, 1 S Prospect St, UHC Rm 4425, Burlington, VT 05401.
2 Department of Radiology, University of Vermont, Burlington, VT.
AJR Am J Roentgenol. 2019 Mar;212(3):706-711. doi: 10.2214/AJR.18.20255. Epub 2019 Jan 23.
The objective of our study was to determine whether detection rates of specific benign and malignant diagnoses differ for breast cancer screening with digital breast tomosynthesis (DBT) versus full-field digital mammography (FFDM) alone.
We analyzed observational data from the Vermont Breast Cancer Surveillance System, including 86,349 DBT screening examinations and 97,378 FFDM screening examinations performed at eight radiology facilities in Vermont that adopted DBT screening during 2012-2016. We determined the most severe diagnosis made within 6 months after positive screening examinations. Multivariable-adjusted logistic regression was used to compare detection rates for specific diagnoses on DBT versus FFDM.
Compared with FFDM, DBT had a lower recall rate (adjusted odds ratio [OR], 0.81; 95% CI, 0.77-0.85) but comparable biopsy rate (OR = 1.05; 95% CI, 0.93-1.17), benign biopsy rate (OR = 1.12; 95% CI, 0.97-1.29), and cancer detection rate (OR = 0.94; 95% CI, 0.78-1.14). Among benign diagnoses, DBT and FFDM had comparable detection rates for nonproliferative lesions (OR = 1.19; 95% CI, 0.92-1.53), fibroepithelial proliferations (OR = 1.24; 95% CI, 0.85-1.81), proliferative lesions without atypia (OR = 1.13; 95% CI, 0.90-1.42), atypical lesions (OR = 0.77; 95% CI, 0.43-1.38), and lobular carcinoma in situ (LCIS) (OR = 0.92; 95% CI, 0.53-1.61). Among malignant diagnoses, DBT and FFDM had comparable detection rates for ductal carcinoma in situ (OR = 1.05; 95% CI, 0.70-1.57) and invasive breast cancer (OR = 0.92; 95% CI, 0.74-1.13), with no statistically significant differences in detection of invasive ductal carcinoma (OR = 0.83; 95% CI, 0.66-1.06), invasive lobular carcinoma (OR = 1.11; 95% CI, 0.59-2.07), or invasive mixed ductal-lobular carcinoma (OR = 1.49; 95% CI, 0.65-3.39).
Compared with FFDM, breast cancer screening with DBT has a lower recall rate while detecting a similar distribution of benign and malignant diagnoses.
本研究旨在确定与单独使用全数字化乳腺摄影术（FFDM）相比，数字乳腺断层合成术（DBT）用于乳腺癌筛查时，特定良性和恶性诊断的检出率是否存在差异。
我们分析了佛蒙特州乳腺癌监测系统的观察性数据，包括在佛蒙特州的 8 个放射学机构进行的 86349 次 DBT 筛查检查和 97378 次 FFDM 筛查检查。我们确定了在阳性筛查检查后 6 个月内做出的最严重诊断。采用多变量调整的逻辑回归比较 DBT 与 FFDM 对特定诊断的检出率。
与 FFDM 相比，DBT 的召回率较低（调整后的优势比[OR]，0.81；95%置信区间，0.77-0.85），但活检率（OR=1.05；95%置信区间，0.93-1.17）、良性活检率（OR=1.12；95%置信区间，0.97-1.29）和癌症检出率（OR=0.94；95%置信区间，0.78-1.14）相当。在良性诊断中，DBT 和 FFDM 对非增生性病变（OR=1.19；95%置信区间，0.92-1.53）、纤维上皮增生（OR=1.24；95%置信区间，0.85-1.81）、非典型增生性病变（OR=1.13；95%置信区间，0.90-1.42）、不典型病变（OR=0.77；95%置信区间，0.43-1.38）和小叶原位癌（LCIS）（OR=0.92；95%置信区间，0.53-1.61）的检出率相当。在恶性诊断中，DBT 和 FFDM 对导管原位癌（OR=1.05；95%置信区间，0.70-1.57）和浸润性乳腺癌（OR=0.92；95%置信区间，0.74-1.13）的检出率相当，浸润性导管癌（OR=0.83；95%置信区间，0.66-1.06）、浸润性小叶癌（OR=1.11；95%置信区间，0.59-2.07）或浸润性混合导管-小叶癌（OR=1.49；95%置信区间，0.65-3.39）的检出率无统计学显著差异。
与 FFDM 相比，DBT 用于乳腺癌筛查时的召回率较低，但检出的良性和恶性诊断分布相似。
