From the Department of Diagnostic Physics (B.H.Ø., A.C.T.M.) and Division of Radiology and Nuclear Medicine (R.G., P.S.), Oslo University Hospital, Building 20, Gaustad, PO Box 4959, Nydalen, 0424 Oslo, Norway; and Institute of Clinical Medicine (B.H.Ø., P.S.) and Department of Physics (A.C.T.M.), University of Oslo, Oslo, Norway.
Radiology. 2019 Oct;293(1):60-68. doi: 10.1148/radiol.2019190425. Epub 2019 Aug 13.
BackgroundPrevious studies comparing digital breast tomosynthesis (DBT) to digital mammography (DM) have shown conflicting results regarding breast density and diagnostic performance.PurposeTo compare true-positive and false-positive interpretations in DM versus DBT according to volumetric density, age, and mammographic findings.Materials and MethodsFrom November 2010 to December 2012, 24 301 women aged 50-69 years (mean age, 59.1 years ± 5.7) were prospectively included in the Oslo Tomosynthesis Screening Trial. Participants received same-compression DM and DBT with independent double reading for both DM and DM plus DBT reading modes. Eight experienced radiologists rated the images by using a five-point scale for probability of malignancy. Participants were followed up for 2 years to assess for interval cancers. Breast density was assessed by using automatic volumetric software (scale, 1-4). Differences in true-positive rates, false-positive rates, and mammographic findings were assessed by using confidence intervals (Newcombe paired method) and values (McNemar and χ tests).ResultsThe true-positive rate of DBT was higher than that of DM for density groups (range, 12%-24%; < .001 for density scores of 2 and 3, and > .05 for density scores of 1 and 4) and age groups (range, 15%-35%; < .05 for all age groups), mainly due to the higher number of spiculated masses and architectural distortions found at DBT ( < .001 for density scores of 2 and 3; < .05 for women aged 55-69 years). The false-positive rate was lower for DBT than for DM in all age groups (range, -0.6% to -1.2%; < .01) and density groups (range, -0.7 to -1.0%; < .005) owing to fewer asymmetric densities ( ≤ .001), except for extremely dense breasts (0.1%, = .82).ConclusionDigital breast tomosynthesis enabled the detection of more cancers in all density and age groups compared with digital mammography, especially cancers classified as spiculated masses and architectural distortions. The improvement in cancer detection rate showed a positive correlation with age. With use of digital breast tomosynthesis, false-positive findings were lower due to fewer asymmetric densities, except in extremely dense breasts.© RSNA, 2019See also the editorial by Fuchsjäger and Adelsmayr in this issue.
背景 与数字乳腺钼靶相比，之前关于数字乳腺断层摄影术的研究结果在乳腺密度和诊断性能方面存在矛盾。
目的 根据体积密度、年龄和乳腺影像学表现，比较数字乳腺钼靶与数字乳腺断层摄影术的真阳性和假阳性解读。
材料与方法 2010 年 11 月至 2012 年 12 月，前瞻性纳入 24 301 名 50-69 岁（平均年龄，59.1 岁±5.7 岁）的女性，参加奥斯陆断层摄影术筛查试验。参与者接受相同压缩的数字乳腺钼靶和数字乳腺断层摄影术检查，两种模式的检查均进行独立的双次读取。8 名经验丰富的放射科医生使用 5 分制评估图像的恶性肿瘤可能性。参与者接受为期 2 年的随访，以评估间隔期癌症。使用自动容积软件（范围 1-4）评估乳腺密度。采用置信区间（Newcombe 配对法）和 值（McNemar 和 χ 检验）评估真阳性率、假阳性率和乳腺影像学表现的差异。
结果 对于密度组（范围 12%-24%；密度评分 2 和 3 时， <.001，密度评分 1 和 4 时， >.05）和年龄组（范围 15%-35%；所有年龄组， <.05），数字乳腺断层摄影术的真阳性率高于数字乳腺钼靶，主要是因为数字乳腺断层摄影术发现了更多的分叶状肿块和结构扭曲（密度评分 2 和 3 时， <.001；55-69 岁女性， <.05）。在所有年龄组（范围 -0.6%至-1.2%； <.01）和密度组（范围 -0.7 至-1.0%； <.005）中，数字乳腺断层摄影术的假阳性率均低于数字乳腺钼靶，这是因为不对称密度（ ≤.001）减少，仅在致密乳腺中除外（0.1%， =.82）。
结论 与数字乳腺钼靶相比，数字乳腺断层摄影术可在所有密度和年龄组中检测到更多的癌症，尤其是分叶状肿块和结构扭曲的癌症。随着年龄的增长，癌症检出率的提高与检测到的癌症数量增加呈正相关。使用数字乳腺断层摄影术时，由于不对称密度减少，假阳性发现减少，仅在致密乳腺中除外。
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