From the Department of Translational Medicine, Diagnostic Radiology, Lund University, Skane University Hospital, Inga Marie Nilssons gata 49, 20502 Malmö, Sweden (K.J., S.Z., A.R., H.S., I.A., K.L.); and Translational Oncogenomics Unit, Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden (L.H.S.).
Radiology. 2019 Nov;293(2):273-281. doi: 10.1148/radiol.2019190132. Epub 2019 Sep 3.
Background Screening accuracy can be improved with digital breast tomosynthesis (DBT). To further evaluate DBT in screening, it is important to assess the molecular subtypes of the detected cancers. Purpose To describe tumor characteristics, including molecular subtypes, of cancers detected at DBT compared with those detected at digital mammography (DM) in breast cancer screening. Materials and Methods The Malmö Breast Tomosynthesis Screening Trial is a prospective, population-based screening trial comparing one-view DBT with two-view DM. Tumor characteristics were obtained, and invasive cancers were classified according to St Gallen as follows: luminal A-like, luminal B-like human epidermal growth factor receptor (HER)2-negative/HER2-positive, HER2-positive, and triple-negative cancers. Tumor characteristics were compared by mode of detection: DBT alone or DM (ie, DBT and DM or DM alone). χ test was used for data analysis. Results Between January 2010 and February 2015, 14 848 women were enrolled (mean age, 57 years ± 10; age range, 40-76 years). In total, 139 cancers were detected; 118 cancers were invasive and 21 were ductal carcinomas in situ. Thirty-seven additional invasive cancers (36 cancers with complete subtypes and stage) were detected at DBT alone, and 81 cancers (80 cancers with complete stage) were detected at DM. No differences were seen between DBT and DM in the distribution of tumor size 20 mm or smaller (86% [31 of 36] vs 85% [68 of 80], respectively; = .88), node-negative status (75% [27 of 36] vs 74% [59 of 80], respectively; = .89), or luminal A-like subtype (53% [19 of 36] vs 46% [37 of 81], respectively; = .48). Conclusion The biologic profile of the additional cancers detected at digital breast tomosynthesis in a large prospective population-based screening trial was similar to those detected at digital mammography, and the majority were early-stage luminal A-like cancers. This indicates that digital breast tomosynthesis screening does not alter the predictive and prognostic profile of screening-detected cancers. © RSNA, 2019.
背景 数字乳腺断层合成术（DBT）可提高背景筛查的准确性。为了进一步评估 DBT 在筛查中的作用，评估所检测癌症的分子亚型很重要。目的 描述与数字乳腺 X 线摄影（DM）筛查相比，DBT 筛查中检测到的癌症的肿瘤特征，包括分子亚型。材料与方法 马尔默乳腺断层合成术筛查试验是一项前瞻性、基于人群的筛查试验，比较了单视图 DBT 与双视图 DM。获得肿瘤特征，并根据圣加仑标准对浸润性癌症进行分类：luminal A 样、luminal B 样人表皮生长因子受体（HER）2 阴性/HER2 阳性、HER2 阳性和三阴性癌症。通过检测方式（单独 DBT 或 DM，即 DBT 和 DM 或 DM 单独）比较肿瘤特征。采用 χ 检验进行数据分析。结果 2010 年 1 月至 2015 年 2 月，共纳入 14848 名女性（平均年龄 57 岁±10 岁；年龄范围 40-76 岁）。共检出 139 例癌症，其中 118 例为浸润性癌症，21 例为导管原位癌。单独 DBT 检出 37 例额外的浸润性癌症（36 例癌症有完整的亚型和分期），DM 检出 81 例癌症（80 例癌症有完整的分期）。DBT 与 DM 之间肿瘤大小 20mm 或更小（分别为 86%[31/36]和 85%[68/80]； =.88）、淋巴结阴性状态（分别为 75%[27/36]和 74%[59/80]； =.89）或 luminal A 样亚型（分别为 53%[19/36]和 46%[37/81]； =.48）的分布无差异。结论 在一项大型前瞻性基于人群的筛查试验中，数字乳腺断层合成术筛查中额外检出的癌症的生物学特征与数字乳腺 X 线摄影筛查中检出的癌症相似，且多数为早期 luminal A 样癌症。这表明数字乳腺断层合成术筛查不会改变筛查检出癌症的预测和预后特征。 ©RSNA，2019.
