From the Cancer Registry of Norway, PO 5313, Maiorstuen, 0304 Oslo, Norway (S.H., N.M., Å.S.H., A.S.D.); Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Services, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia (N.H.); Department of Radiology (H.S.A., I.S.H.), Department of Pathology (L.A.A.), and Mohn Medical Imaging and Visualization Centre (I.S.H.), Haukeland University Hospital, Bergen, Norway; and Department of Clinical Medicine (H.S.A., I.S.H.), Section for Pathology (L.A.A.), and Centre for Cancer Biomarkers CCBIO (L.A.A.), University of Bergen, Bergen, Norway.
Radiology. 2021 Jul;300(1):66-76. doi: 10.1148/radiol.2021203936. Epub 2021 May 11.
Background Prevalent digital breast tomosynthesis (DBT) has shown higher cancer detection rates and lower recall rates compared with those of digital mammography (DM). However, data are limited on rates and histopathologic tumor characteristics of interval and subsequent round screen-detected cancers for DBT. Purpose To follow women randomized to screening with DBT or DM and to investigate rates and tumor characteristics of interval and subsequent round screen-detected cancers. Materials and Methods To-Be is a randomized controlled trial comparing the outcome of DBT and DM in organized breast cancer screening. The trial included 28 749 women, with 22 306 women returning for subsequent DBT screening 2 years later (11 201 and 11 105 originally screened with DBT and DM, respectively). Differences in rates, means, and distribution of histopathologic tumor characteristics between women prevalently screened with DBT versus DM were evaluated with Z tests, tests, and χ tests. Relative risk (RR) with 95% CIs was calculated for the cancer rates. Results Interval cancer rates were 1.4 per 1000 screens (20 of 14 380; 95% CI: 0.9, 2.1) for DBT versus 2.0 per 1000 screens (29 of 14 369; 95% CI: 1.4, 2.9; = .20) for DM. The rates of subsequent round screen-detected cancer were 8.1 per 1000 (95% CI: 6.6, 10.0) for women originally screened with DBT and 9.1 per 1000 (95% CI: 7.4, 11.0; = .43) for women screened with DM. The distribution of tumor characteristics did not differ between groups for either interval or subsequent screen-detected cancer. The RR of interval cancer was 0.69 (95% CI: 0.39, 1.22; = .20) for DBT versus DM, whereas RR of subsequent screen-detected cancer for women prevalently screened with DBT versus DM was 0.89 (95% CI: 0.67, 1.19; = .43). Conclusion Rates of interval or subsequent round screen-detected cancers and their tumor characteristics did not differ between women originally screened with digital breast tomosynthesis (DBT) versus digital mammography. The analysis suggests that the benefits of prevalent DBT screening did not come at the expense of worse downstream screening performance measures in a population-based screening program. © RSNA, 2021 See also the editorial by Taourel in this issue.
背景 与数字乳腺断层摄影术（DBT）相比，数字乳腺摄影术（DM）的癌症检出率更高，召回率更低。然而，关于 DBT 间隔和后续轮次筛查发现癌症的发生率和组织病理学肿瘤特征的数据有限。目的 随访接受 DBT 或 DM 筛查随机分组的女性，以调查间隔和后续轮次筛查发现癌症的发生率和肿瘤特征。材料与方法 To-Be 是一项比较 DBT 和 DM 在有组织乳腺癌筛查中的效果的随机对照试验。该试验纳入 28749 名女性，其中 22306 名女性在 2 年后接受后续 DBT 筛查（11201 名和 11105 名女性最初分别接受 DBT 和 DM 筛查）。采用 Z 检验、卡方检验和 t 检验评估 DBT 与 DM 相比，在普遍筛查女性中癌症发生率、平均值和组织病理学肿瘤特征分布的差异。计算癌症发生率的相对风险（RR）及其 95%置信区间（CI）。结果 与 DBT 相比，DM 的间隔期癌症发生率为每 1000 次筛查 1.4 例（20/14380；95%CI：0.9，2.1），DM 为每 1000 次筛查 2.0 例（29/14369；95%CI：1.4，2.9；=0.20）。最初接受 DBT 筛查的女性中，后续轮次筛查发现癌症的发生率为 8.1/1000（95%CI：6.6，10.0），而最初接受 DM 筛查的女性为 9.1/1000（95%CI：7.4，11.0；=0.43）。两组在间隔期或后续轮次筛查发现的癌症中，肿瘤特征分布均无差异。DBT 与 DM 相比，间隔期癌症的 RR 为 0.69（95%CI：0.39，1.22；=0.20），而 DBT 与 DM 相比，DBT 筛查女性的后续轮次筛查发现癌症的 RR 为 0.89（95%CI：0.67，1.19；=0.43）。结论 最初接受数字乳腺断层摄影术（DBT）或数字乳腺摄影术（DM）筛查的女性中，间隔期或后续轮次筛查发现癌症的发生率及其肿瘤特征并无差异。该分析表明，在基于人群的筛查项目中，DBT 普遍筛查的益处并没有以更差的下游筛查效果指标为代价。©2021 RSNA。 本期杂志还刊登了 Taourel 撰写的社论。
