实施数字乳腺断层摄影术（DBT）替代乳腺摄影术对人群筛查结果（包括间期癌发生率）的影响：特伦托 DBT 试点评估结果。
Effect of implementing digital breast tomosynthesis (DBT) instead of mammography on population screening outcomes including interval cancer rates: Results of the Trento DBT pilot evaluation.
机构信息
Breast Imaging and Screening Unit, Department of Radiology, Humanitas Research Hospital, Milano, Italy.
Servizio Epidemiologia Clinica e Valutativa, Azienda Provinciale Servizi Sanitari (APSS) Trento, Italy.
出版信息
Breast. 2020 Apr;50:135-140. doi: 10.1016/j.breast.2019.09.012. Epub 2019 Sep 30.
BACKGROUND/AIM: The Trento screening program transitioned to digital breast tomosynthesis (DBT) screening based on evidence that DBT improves breast cancer (BC) detection compared to mammography; an evaluation of the transition to DBT is reported in this pilot study.
METHODS
Prospective implementation of DBT screening included women aged ≥50 years who attended the Trento program for biennial screening. DBT screening included DBT acquisitions with synthesized 2D-images. A historical cohort of women who attended the program (January 2013-October 2014) and received digital mammography (DM) provided a comparison group. Independent double-reading (with a third arbitrating read for discordance) was used for DBT and DM screening. Screening outcomes included cancer detection rate (CDR/1000 screens), percentage of screens recalled to assessment (recall%), interval cancer rate (ICR/1000 screens) at 2-year follow-up, and screening sensitivity. Rate ratios (RR) and 95% confidence interval (95%CI) examined outcomes for DBT versus DM screening.
RESULTS
From women aged 50-69 years who accepted an invitation to screening (October 2014-October 2016) 46,343 comprised the DBT-screened group: amongst these 402 BCs (includes 50 ductal carcinoma in-situ (DCIS)) were detected (CDR 8.67/1000), whereas 205 BCs (includes 33 DCIS) were detected amongst 37,436 DM screens (CDR 5.48/1000) [RR for CDR:1.58 (1.34-1.87)]. Recall% was lower for DBT (2.55%) than DM (3.21%) [RR:0.79 (0.73-0.86)]. Compared to DM, DBT screening increased CDR for stage I-II BC, for all tumour size and grade categories, and for node-negative BC, but did not increase CDR for DCIS. Estimated ICR for DBT was 1.1/1000 whereas ICR for DM was 1.36/1000 [RR:0.81 (0.55-1.19)]. Screening sensitivity was 88.74% for DBT versus 80.08% for DM [RR:1.11 (0.94-1.31)].
CONCLUSION
DBT significantly improved early-detection measures but did not significantly reduce ICR (relative to DM screening), suggesting that it could add benefit as well as adding over-detection in population BC screening.
背景/目的：特伦托筛查项目已过渡到数字乳腺断层摄影术（DBT）筛查，因为有证据表明 DBT 可提高乳腺癌（BC）的检出率，与乳房 X 线摄影相比；本试点研究报告了向 DBT 过渡的评估情况。
方法
前瞻性实施 DBT 筛查包括年龄≥50 岁、参加特伦托项目进行两年一次筛查的女性。DBT 筛查包括 DBT 采集和合成的 2D 图像。2013 年 1 月至 2014 年 10 月参加该计划并接受数字乳房 X 线摄影（DM）的女性为历史对照队列。DBT 和 DM 筛查均采用独立的双读（不一致时由第三方仲裁）。筛查结果包括每 1000 例筛查的癌症检出率（CDR/1000 例）、召回评估的比例（召回率）%、2 年随访时的间隔癌率（ICR/1000 例）和筛查敏感性。率比（RR）和 95%置信区间（95%CI）检查了 DBT 与 DM 筛查的结果。
结果
从接受筛查邀请的 50-69 岁女性中（2014 年 10 月至 2016 年 10 月），46343 名女性接受了 DBT 筛查：其中 402 名 BC（包括 50 例导管原位癌（DCIS））被检出（CDR 8.67/1000），而在 37436 名 DM 筛查中检出 205 例 BC（包括 33 例 DCIS）（CDR 5.48/1000）[CDR 的 RR：1.58（1.34-1.87）]。DBT 的召回率（2.55%）低于 DM（3.21%）[RR：0.79（0.73-0.86）]。与 DM 相比，DBT 筛查提高了 I 期-II 期 BC、所有肿瘤大小和分级类别的 CDR，以及淋巴结阴性 BC 的 CDR，但未提高 DCIS 的 CDR。DBT 的估计 ICR 为 1.1/1000，而 DM 的 ICR 为 1.36/1000[RR：0.81（0.55-1.19）]。DBT 的筛查敏感性为 88.74%，DM 为 80.08%[RR：1.11（0.94-1.31）]。
结论
DBT 显著提高了早期检测指标，但未显著降低 ICR（与 DM 筛查相比），这表明它在人群 BC 筛查中不仅增加了过度检测，还可能带来益处。
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