数字乳腺钼靶摄影与数字乳腺断层合成摄影中导管原位癌的检出率及其病理升级的预测因素。
Ductal carcinoma in situ on digital mammography versus digital breast tomosynthesis: rates and predictors of pathologic upgrade.
机构信息
Department of Radiology, Division of Breast Imaging, Massachusetts General Hospital, 55 Fruit Street, WAC 240, Boston, MA, 02114, USA.
Department of Surgery, Division of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
出版信息
Eur Radiol. 2020 Nov;30(11):6089-6098. doi: 10.1007/s00330-020-07021-2. Epub 2020 Jun 26.
OBJECTIVES
To compare upgrade rates of ductal carcinoma in situ (DCIS) on digital mammography (DM) versus digital breast tomosynthesis (DBT) and identify patient, imaging, and pathological features associated with upgrade risk.
METHODS
A retrospective review was performed of 318 women (mean 59 years, range 37-89) with screening-detected DCIS from 2007 to 2011 (DM group) and from 2013 to 2016 (DBT group). Comparisons made between DM and DBT groups using the unpaired t test and chi-square test include detection rates of DCIS, upgrade rates to invasive cancer, and pathological features of DCIS and upgraded cases. Patient, imaging, and pathological features associated with upgrade were also determined. P values < 0.05 were considered significant.
RESULTS
There was no significant difference in detection rates of DCIS between DM and DBT groups (0.9 versus 1.0 per 1000 examinations, p = 0.45). Upgrade rates of DCIS to invasive cancer in DM and DBT groups were similar (17.3% versus 16.8%, p = 0.90), despite significant differences in pathological features of DCIS between DM and DBT groups (including nuclear grade, comedonecrosis, and progesterone receptor status [p ≤ 0.01]). Among upgraded cases, a higher proportion were high-grade invasive cancers with DBT (36.7% versus 9.5%, p = 0.03). In both groups, ultrasound-guided (versus stereotactic) biopsy was associated with higher upgrade risk (p ≤ 0.03).
CONCLUSIONS
There was no significant difference in detection rates or upgrade rates of DCIS on DM versus DBT; however, upgraded cases were more likely to be high grade with DBT, suggesting possible differences in tumor biology between cancers with DM and DBT. In both DM and DBT groups, biopsy modality was associated with upgrade risk.
KEY POINTS
• Detection rates and upgrade rates of ductal carcinoma in situ (DCIS) on digital mammography (DM) versus digital breast tomosynthesis (DBT) are similar. • A higher proportion of upgraded cases were high-grade invasive cancers with DBT than DM, suggesting possible differences in tumor biology between cancers that are detected with DM and DBT. • With both DM and DBT, ultrasound-guided biopsy (versus stereotactic biopsy) was associated with a higher risk of upgrade.
目的
比较数字乳腺断层摄影术（DBT）与数字乳腺钼靶摄影术（DM）检测导管原位癌（DCIS）的升级率，并确定与升级风险相关的患者、影像学和病理学特征。
方法
回顾性分析了 2007 年至 2011 年（DM 组）和 2013 年至 2016 年（DBT 组）筛查发现的 318 例 DCIS 患者的资料（平均年龄 59 岁，范围 37-89 岁）。使用独立样本 t 检验和卡方检验对 DM 组和 DBT 组进行比较，比较内容包括 DCIS 的检出率、升级为浸润性癌的比例以及 DCIS 和升级病例的病理学特征。还确定了与升级相关的患者、影像学和病理学特征。P 值<0.05 被认为具有统计学意义。
结果
DM 组和 DBT 组 DCIS 的检出率无显著差异（每 1000 例检查分别为 0.9 和 1.0，p=0.45）。DM 组和 DBT 组 DCIS 升级为浸润性癌的比例相似（分别为 17.3%和 16.8%，p=0.90），尽管 DM 组和 DBT 组的 DCIS 病理学特征存在显著差异（包括核分级、坏死和孕激素受体状态[ p≤0.01]）。在升级病例中，DBT 组的高级别浸润性癌比例更高（36.7%和 9.5%，p=0.03）。在两组中，超声引导（而非立体定向）活检与更高的升级风险相关（p≤0.03）。
结论
DM 与 DBT 检测 DCIS 的检出率或升级率无显著差异；然而，DBT 组的升级病例更可能为高级别浸润性癌，这表明 DM 和 DBT 检测到的癌症之间可能存在肿瘤生物学差异。在 DM 和 DBT 组中，活检方式与升级风险相关。
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