Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 3rd Fl Main Bldg, 593 Eddy St, Providence, RI 02903.
Lifespan Biostatistics Core, Providence, RI.
AJR Am J Roentgenol. 2019 Dec;213(6):1397-1402. doi: 10.2214/AJR.18.20748. Epub 2019 Sep 25.
The objective of this study was to compare the yield of dense breast ultrasound (US) screening after digital mammography (DM) versus after digital breast tomosyn-thesis (DBT). For this institutional review board-approved, HIPAA-compliant study, we retrospectively searched databases at two tertiary breast imaging centers and an office practice staffed by the same fellowship-trained breast radiologists for screening US examinations from October 1, 2014, to September 30, 2016. Prior DM versus DBT and screening US and pathology results were recorded. Mammographically occult cancers detected with US and additional benign lesions requiring biopsy were calculated. Differences between DM and DBT were compared using the two-sample proportions test. A total of 3183 screening breast US examinations were performed, 1434 (45.1%) after DM and 1668 (52.4%) after DBT. Of the 3183 examinations, 81 (2.5%) had no prior mammogram available. Of the 122 DM and DBT patients for whom biopsy or cyst aspiration was recommended (all BI-RADS assessment category 4 or BI-RADS assessment category 5 studies), 118 (96.7%) had biopsy or cyst aspiration results available. Of the 36 biopsies or aspirations after DM, 6 (16.7%) were malignant and 30 (83.3%) were benign; of the 82 biopsies or aspirations after DBT, 11 (13.4%) were malignant and 71 (86.6%) were benign ( = 0.8583). The additional cancer detection rate by US after DM was 5/1434 or 3.5 per 1000 women screened and after DBT was 5/1668 or 3.0 per 1000 women screened ( = 0.9999). No significant difference in additional cancer detection rate was found with screening US after DM versus after DBT.
本研究的目的是比较数字乳腺断层合成术（DBT）与数字乳腺钼靶摄影（DM）后密集型乳腺超声（US）筛查的检出率。这项经机构审查委员会批准、符合 HIPAA 规定的回顾性研究，检索了两家三级乳腺影像中心和一家由同一位 fellowship 培训的乳腺放射科医生组成的办公实践的数据库，以获取 2014 年 10 月 1 日至 2016 年 9 月 30 日的筛查性 US 检查。记录了之前的 DM 与 DBT 以及筛查性 US 和病理结果。计算了 US 检测到的乳腺钼靶摄影隐匿性癌症和需要活检的其他良性病变。使用两样本比例检验比较 DM 和 DBT 之间的差异。共进行了 3183 次筛查性乳腺 US 检查，1434 次（45.1%）在 DM 之后，1668 次（52.4%）在 DBT 之后。在 3183 次检查中，有 81 次（2.5%）没有先前的乳腺钼靶摄影可用。在 122 例 DM 和 DBT 患者中，建议进行活检或囊肿抽吸术（所有 BI-RADS 评估类别 4 或 BI-RADS 评估类别 5 研究），有 118 例（96.7%）的活检或囊肿抽吸术结果可用。在 36 例 DM 后活检或抽吸中，有 6 例（16.7%）为恶性，30 例（83.3%）为良性；在 82 例 DBT 后活检或抽吸中，有 11 例（13.4%）为恶性，71 例（86.6%）为良性（=0.8583）。DM 后 US 额外检出的癌症发生率为 5/1434 例，即每 1000 名筛查女性中有 3.5 例，DBT 后为 5/1668 例，即每 1000 名筛查女性中有 3.0 例（=0.9999）。DM 后与 DBT 后 US 筛查的额外癌症检出率无显著差异。
