Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Australia; Department of Radiological Sciences, Faculty of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia.
Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Australia.
Clin Breast Cancer. 2021 Aug;21(4):278-291. doi: 10.1016/j.clbc.2021.03.006. Epub 2021 Mar 16.
PURPOSE: To compare the diagnostic performance of mammography (MG) alone versus MG combined with adjunctive imaging modalities, including handheld ultrasound (HHUS), automated breast ultrasound (ABUS), digital breast tomosynthesis (DBT), contrast-enhanced mammography (CEM), and magnetic resonance imaging (MRI) in women with non-dense and dense breasts. PATIENTS AND METHODS: Medline, Embase, PubMed, CINAHL, Scopus, and the Web of Science databases were searched up to October 2019. Quality assessment was performed using QUADAS-2. RevMan 5.3 was used to conduct a meta-analysis of the studies. RESULTS: In dense breasts, adding adjunctive modalities significantly increased cancer detection rates (CDRs): HHUS (relative risk [RR] = 1.49; 95% confidence interval [CI], 1.19-1.86; P = .0005); ABUS (RR = 1.44; 95% CI, 1.16-1.78; P = .0008); DBT (RR = 1.38; 95% CI, 1.14-1.67; P = .001); CEM (RR = 1.37; 95% CI, 1.12-1.69; P = .003); and MRI (RR = 2.16; 95% CI, 1.81-2.58; P < .00001). The recall rate was significantly increased by HHUS (RR = 2.03; 95% CI, 1.89-2.17; P < .00001), ABUS (RR = 1.90; 95% CI, 1.81-1.99; P < .00001), and MRI (RR = 2.71; 95% CI, 1.73-4.25; P < .0001), but not by DBT (RR = 1.14; 95% CI, 0.95-1.36; P = .15). In non-dense breasts, HHUS and MRI showed significant increases in CDRs but not DBT: HHUS (RR = 1.14; 95% CI, 1.01-1.29; P = .04); MRI (RR = 1.78; 95% CI, 1.14-2.77; P = .01); and DBT (RR = 1.09; 95% CI, 1.13-1.75; P = .08). The recall rate was also significantly increased by HHUS (RR = 1.43; 95% CI, 1.28-1.59; P < .00001) and MRI (RR = 3.01; 95% CI, 1.68-5.39; P = .0002), whereas DBT showed a non-significant reduction (RR = 0.83; 95% CI, 0.65-1.05; P = .12). CONCLUSION: Adding adjunctive modalities to MG increases CDRs in women with dense and non-dense breasts. Ultrasound and MRI increase recall rates across all breast densities; however, MRI results in higher values for both CDRs and recall rates.
目的：比较在非致密性和致密性乳腺的女性中，乳腺 X 线摄影（MG）与 MG 联合辅助成像方式（包括手持超声（HHUS）、自动乳腺超声（ABUS）、数字乳腺断层合成（DBT）、对比增强乳腺摄影（CEM）和磁共振成像（MRI））的诊断性能。
方法：检索 Medline、Embase、PubMed、CINAHL、Scopus 和 Web of Science 数据库，截至 2019 年 10 月。使用 QUADAS-2 进行质量评估。使用 RevMan 5.3 对研究进行荟萃分析。
结果：在致密性乳腺中，联合辅助方式显著提高了癌症检出率（CDR）：HHUS（相对风险 [RR] 1.49；95%置信区间 [CI]，1.19-1.86；P =.0005）；ABUS（RR 1.44；95% CI，1.16-1.78；P =.0008）；DBT（RR 1.38；95% CI，1.14-1.67；P =.001）；CEM（RR 1.37；95% CI，1.12-1.69；P =.003）；和 MRI（RR 2.16；95% CI，1.81-2.58；P <.00001）。HHUS（RR 2.03；95% CI，1.89-2.17；P <.00001）、ABUS（RR 1.90；95% CI，1.81-1.99；P <.00001）和 MRI（RR 2.71；95% CI，1.73-4.25；P <.0001）显著增加了召回率，但 DBT 则没有（RR 1.14；95% CI，0.95-1.36；P =.15）。在非致密性乳腺中，HHUS 和 MRI 显著提高了 CDR，但 DBT 则没有：HHUS（RR 1.14；95% CI，1.01-1.29；P =.04）；MRI（RR 1.78；95% CI，1.14-2.77；P =.01）；和 DBT（RR 1.09；95% CI，1.13-1.75；P =.08）。HHUS（RR 1.43；95% CI，1.28-1.59；P <.00001）和 MRI（RR 3.01；95% CI，1.68-5.39；P =.0002）也显著增加了召回率，而 DBT 则显示出非显著的降低（RR 0.83；95% CI，0.65-1.05；P =.12）。
结论：在致密性和非致密性乳腺的女性中，MG 联合辅助成像方式可提高 CDR。超声和 MRI 提高了所有乳腺密度的召回率；然而，MRI 对 CDR 和召回率都有更高的数值。
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