数字乳腺断层合成摄影与数字乳腺钼靶摄影筛查乳腺癌的种族差异结果。
Outcomes by Race in Breast Cancer Screening With Digital Breast Tomosynthesis Versus Digital Mammography.
机构信息
Section Chief, Division Breast Imaging. Co-Medical Director, Advocate Caldwell Breast Center; Chair, Advocate Breast Imaging Medical Directors Committee; Chair, AAHC Imaging Research Council; Advocate Lutheran General Hospital, Park Ridge, Illinois.
President and CEO of Black Women's Health Imperative; Vice-Chair of the board of Creating Healthier Communities; Chair of the Rare Disease Diversity Coalition, Washington, District of Columbia.
出版信息
J Am Coll Radiol. 2021 Jul;18(7):906-918. doi: 10.1016/j.jacr.2020.12.033. Epub 2021 Feb 17.
PURPOSE
Digital breast tomosynthesis (DBT) in conjunction with digital mammography (DM) is becoming the preferred imaging modality for breast cancer screening compared with DM alone, on the basis of improved recall rates (RR) and cancer detection rates (CDRs). The aim of this study was to investigate racial differences in the utilization and performance of screening modality.
METHODS
Retrospective data from 63 US breast imaging facilities from 2015 to 2019 were reviewed. Screening outcomes were linked to cancer registries. RR, CDR per 1,000 examinations, and positive predictive value for recall (cancers/recalled patients) were compared.
RESULTS
A total of 385,503 women contributed 542,945 DBT and 261,359 DM screens. A lower proportion of screenings for Black women were performed using DBT plus DM (referred to as DBT) (44% for Black, 48% for other, 63% for Asian, and 61% for White). Non-White women were less likely to undergo more than one mammographic examination. RRs were lower for DBT among all women (8.74 versus 10.06, P < .05) and lower across all races and within age categories. RRs were significantly higher for women with only one mammogram. CDRs were similar or higher in women undergoing DBT compared with DM, overall (4.73 versus 4.60, adjusted P = .0005) and by age and race. Positive predictive value for recall was greater for DBT overall (5.29 versus 4.45, adjusted P < .0001) and by age, race, and screening frequency.
CONCLUSIONS
All racial groups had improved outcomes with DBT screening, but disparities were observed in DBT utilization. These data suggest that reducing inequities in DBT utilization may improve the effectiveness of breast cancer screening.
目的
与单独使用数字乳房 X 线摄影术（DM）相比，数字乳腺断层融合成像（DBT）在提高召回率（RR）和癌症检出率（CDR）的基础上，成为乳腺癌筛查的首选成像方式。本研究旨在探讨筛查方式应用中的种族差异。
方法
回顾了 2015 年至 2019 年美国 63 个乳腺成像机构的回顾性数据。将筛查结果与癌症登记处相关联。比较了 RR、每千次检查的 CDR 以及召回的阳性预测值（每例召回患者的癌症数）。
结果
共有 385503 名女性进行了 542945 次 DBT 和 261359 次 DM 筛查。黑人女性进行 DBT 加 DM 筛查（称为 DBT）的比例较低（黑人女性为 44%，其他种族女性为 48%，亚洲女性为 63%，白人女性为 61%）。非白人女性接受多次乳房 X 线检查的可能性较小。所有女性的 DBT 检出率均较低（8.74 比 10.06，P <.05），且所有种族和年龄组的 DBT 检出率均较低。仅接受一次乳房 X 线检查的女性 RR 明显更高。总体而言，与 DM 相比，接受 DBT 的女性的 CDR 相似或更高（4.73 比 4.60，调整后 P =.0005），且按年龄和种族分类。总体而言，DBT 的召回阳性预测值更高（5.29 比 4.45，调整后 P <.0001），且按年龄、种族和筛查频率分类。
结论
所有种族组的 DBT 筛查结果均有所改善，但 DBT 的应用存在差异。这些数据表明，减少 DBT 应用中的不平等可能会提高乳腺癌筛查的效果。
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