From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting.
Radiology. 2019 Oct;293(1):81-88. doi: 10.1148/radiol.2019182660. Epub 2019 Aug 27.
BackgroundContrast agent-enhanced digital mammography (CEDM) has been shown to be more sensitive and specific than two-dimensional full-field digital mammography in the diagnostic setting. Few studies have reported on its performance in the screening setting.PurposeTo evaluate the performance of CEDM for breast cancer screening.Materials and MethodsThis retrospective study included women who underwent dual-energy CEDM for breast cancer screening from December 2012 through April 2016. Medical records were reviewed for age, risk factors, short-interval follow-up and biopsies recommended, and cancers detected. Sensitivity, specificity, positive predictive value of abnormal findings at screening (PPV), positive predictive value of biopsy performed (PPV), and negative predictive value were determined.ResultsIn the study period 904 baseline CEDMs were performed. Mean age was 51.8 years ± 9.4 (standard deviation). Of 904 patients, 700 (77.4%) had dense breasts, 247 (27.3%) had a family history of breast cancer in a first-degree relative age 50 years or younger, and 363 (40.2%) a personal history of breast cancer. The final Breast Imaging Reporting and Data System score was 1 or 2 in 832 of 904 (92.0%) patients, score of 3 in 25 of 904 (2.8%) patients, and score of 4 or 5 in 47 of 904 (5.2%) patients. By using CEDM, 15 cancers were diagnosed in 14 of 904 women (cancer detection rate, 15.5 of 1000). PPV was 29.4% (15 of 51). At least 1-year follow up was available in 858 women. There were two interval cancers. Sensitivity was 50.0% (eight of 16; 95% confidence interval [CI]: 24.7%, 75.3%) on the low-energy images compared with 87.5% (14 of 16; 95% CI: 61.7%, 98.4%) for the entire study (low-energy and iodine images; = .03). Specificity was 93.7% (789 of 842; 95% CI: 91.8%, 95.2%); PPV was 20.9% (14 of 67; 95% CI: 11.9%, 32.6%), and negative predictive value was 99.7% (789 of 791; 95% CI: 99.09%, 99.97%).ConclusionContrast-enhanced digital mammography is a promising technique for screening women with higher-than-average risk for breast cancer.© RSNA, 2019.
背景
与二维全视野数字乳腺摄影相比，对比增强数字乳腺摄影（CEDM）在诊断环境中具有更高的敏感性和特异性。很少有研究报告其在筛查环境中的性能。
目的
评估 CEDM 用于乳腺癌筛查的性能。
材料与方法
本回顾性研究纳入了 2012 年 12 月至 2016 年 4 月期间因乳腺癌筛查而接受双能 CEDM 的女性。回顾了病历，以了解年龄、危险因素、短间隔随访和推荐活检以及检出的癌症情况。确定了筛查时异常发现的敏感性、特异性、阳性预测值（PPV）、活检阳性预测值（PPV）和阴性预测值。
结果
在研究期间，共进行了 904 次基线 CEDM。平均年龄为 51.8 岁±9.4（标准差）。904 例患者中，700 例（77.4%）乳腺致密，247 例（27.3%）一级亲属 50 岁或更年轻有乳腺癌病史，363 例（40.2%）有乳腺癌个人史。最终的乳腺影像报告和数据系统评分在 904 例患者中的 832 例（92.0%）为 1 或 2 分，在 904 例患者中的 25 例（2.8%）为 3 分，在 904 例患者中的 47 例（5.2%）为 4 或 5 分。使用 CEDM，在 904 名女性中的 14 名（癌症检出率为 15.5/1000）中诊断出 15 例癌症。PPV 为 29.4%（15/51）。858 名女性至少有 1 年的随访。有 2 例间隔期癌症。低能图像的敏感性为 50.0%（16 例中的 8 例；95%置信区间[CI]：24.7%，75.3%），而整个研究（低能和碘图像）的敏感性为 87.5%（16 例中的 14 例；95%CI：61.7%，98.4%）（ =.03）。特异性为 93.7%（789/842；95%CI：91.8%，95.2%）；PPV 为 20.9%（14/67；95%CI：11.9%，32.6%），阴性预测值为 99.7%（789/791；95%CI：99.09%，99.97%）。
结论
对比增强数字乳腺摄影是一种有前途的技术，可用于筛查乳腺癌风险较高的女性。
©RSNA，2019。
