Department of Radiology, Memorial Sloan Kettering Cancer Center, Breast Imaging Service, 300 E 66th St, New York, NY 10065.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
AJR Am J Roentgenol. 2021 Jun;216(6):1486-1491. doi: 10.2214/AJR.20.23480. Epub 2021 Mar 31.
The objective of this study was to assess to the role of contrast-enhanced digital mammography (CEDM) as a screening tool in women at intermediate risk for developing breast cancer due to a personal history of lobular neoplasia without additional risk factors. In this institutional review board-approved, observational, retrospective study, we reviewed our radiology department database to identify patients with a personal history of breast biopsy yielding lobular neoplasia who underwent screening CEDM at our institution between December 2012 and February 2019. A total of 132 women who underwent 306 CEDM examinations were included. All CEDM examinations were interpreted by dedicated breast imaging radiologists in conjunction with a review of the patient's clinical history and available prior breast imaging. In statistical analysis, sensitivity, specificity, NPV, positive likelihood ratio, and accuracy of CEDM in detecting cancer were determined, with pathology or 12-month imaging follow-up serving as the reference standard. CEDM detected cancer in six patients and showed an overall sensitivity of 100%, specificity of 88% (95% CI, 84-92%), NPV of 100%, and accuracy of 88% (95% CI, 84-92%). The positive likelihood ratio of 8.33 suggested that CEDM findings are 8.3 times more likely to be positive in an individual with breast cancer when compared with an individual without the disease. CEDM shows promise as a breast cancer screening examination in patients with a personal history of lobular neoplasia. Continued investigation with a larger patient population is needed to determine the true sensitivity and positive predictive value of CEDM for these patients.
本研究旨在评估对比增强数字乳腺摄影（CEDM）作为一种筛查工具在因个人史有乳腺小叶肿瘤且无其他危险因素而处于乳腺癌发展中危的女性中的作用。在这项经机构审查委员会批准的、观察性、回顾性研究中，我们回顾了放射科数据库，以确定在我们机构进行筛查性 CEDM 检查的个人史有乳腺活检结果为乳腺小叶肿瘤的患者。共有 132 名女性接受了 306 次 CEDM 检查。所有 CEDM 检查均由专门的乳腺影像放射科医生进行解读，并结合患者的临床病史和可用的既往乳腺影像进行回顾。在统计分析中，确定了 CEDM 在检测癌症方面的敏感性、特异性、NPV、阳性似然比和准确性，以病理或 12 个月的影像学随访作为参考标准。CEDM 在 6 名患者中检测到癌症，总体敏感性为 100%，特异性为 88%（95%CI，84-92%），NPV 为 100%，准确性为 88%（95%CI，84-92%）。阳性似然比为 8.33，表明与没有该疾病的个体相比，CEDM 结果在患有乳腺癌的个体中更有可能呈阳性。需要对更大的患者群体进行进一步研究，以确定 CEDM 对这些患者的真正敏感性和阳性预测值。
