数字化乳腺断层合成与数字化乳腺钼靶人群筛查的间期乳腺癌发病率：一项荟萃分析。

Interval breast cancer rates for digital breast tomosynthesis versus digital mammography population screening: An meta-analysis.

作者信息

Houssami Nehmat, Hofvind Solveig, Soerensen Anne L, Robledo Kristy P, Hunter Kylie, Bernardi Daniela, Lång Kristina, Johnson Kristin, Aglen Camilla F, Zackrisson Sophia

机构信息

Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.

Section of Breast Screening, Cancer Registry of Norway, Oslo, Norway.

出版信息

EClinicalMedicine. 2021 Mar 20;34:100804. doi: 10.1016/j.eclinm.2021.100804. eCollection 2021 Apr.

BACKGROUND

Digital breast tomosynthesis (DBT) improves breast cancer (BC) detection compared to mammography, however, it is unknown whether this reduces (ICR) at follow-up.

METHODS

Using (IPD) from DBT screening studies (identified via periodic literature searches July 2016 to November 2019) we performed an IPD meta-analysis. We estimated ICR for DBT-screened participants and the difference in pooled ICR for DBT and mammography-only screening, and compared interval BC characteristics. Two-stage meta-analysis (study-specific estimation, pooled synthesis) of ICR included random-effects, adjusting for study and age, and was estimated in age and density subgroups. Comparative screening sensitivity was calculated using screen-detected and interval BC data.

FINDINGS

Four prospective DBT studies, from European population-based programs, contributed IPD for 66,451 DBT-screened participants: age-adjusted pooled ICR was 13.17/10,000 (95%CI: 8.25-21.02). Pooled ICR was higher in the high-density (21.08/10,000; 95%CI: 6.71-66.27) than the low-density (8.63/10,000; 95%CI: 5.25-14.192) groups ( = 0.03) however estimates did not differ across age-groups ( = 0.32). Based on two studies that also provided data for 153,800 mammography screens (age-adjusted ICR 17.69/10,000; 95%CI: 13.22-23.66), DBT's pooled ICR was 16.83/10,000 (95%CI: 11.89-23.82). Comparative meta-analysis showed a non-significant difference in ICR (-0.44/10,000; 95%CI: -11.00-10.11) and non-significant difference in screening sensitivity (6.79%; 95%CI: -0.73-14.87%) between DBT and DM but a significant pooled in cancer detection rate of 33.49/10,000 (95%CI: 23.88-43.10). Distribution of interval BC prognostic characteristics did not differ between screening modalities except that those occurring in DBT-screened participants were significantly more likely to be negative for axillary-node metastases ( = 0.005).

INTERPRETATION

Although heterogeneity in ICR estimates and few datasets limit recommendations, there was no difference between DBT and mammography in pooled ICR despite DBT increasing cancer detection.

背景

与乳腺钼靶摄影相比，数字乳腺断层合成（DBT）可提高乳腺癌（BC）的检出率，然而，随访时其是否能降低间期癌（ICR）尚不清楚。

方法

利用DBT筛查研究（通过2016年7月至2019年11月定期文献检索确定）的个体参与者数据（IPD）进行IPD荟萃分析。我们估计了接受DBT筛查参与者的ICR，以及DBT和单纯乳腺钼靶摄影筛查的合并ICR差异，并比较了间期BC的特征。ICR的两阶段荟萃分析（研究特异性估计，合并合成）包括随机效应，对研究和年龄进行调整，并在年龄和密度亚组中进行估计。使用筛查发现的和间期BC数据计算比较筛查敏感性。

结果

来自欧洲基于人群项目的四项前瞻性DBT研究为66451名接受DBT筛查的参与者提供了IPD：年龄调整后的合并ICR为13.17/10000（95%CI：8.25 - 21.02）。高密度组（21.08/10000；95%CI：6.71 - 66.27）的合并ICR高于低密度组（8.63/10000；95%CI：5.25 - 14.192）（P = 0.03），但各年龄组的估计值无差异（P = 0.32）。基于两项也提供了153800次乳腺钼靶筛查数据（年龄调整后的ICR为17.69/10000；95%CI：13.22 - 23.66）的研究，DBT的合并ICR为16.83/10000（95%CI：11.89 - 23.82）。比较荟萃分析显示，DBT和乳腺钼靶摄影在ICR方面无显著差异（-0.44/10000；95%CI：-11.00 - 10.11），在筛查敏感性方面也无显著差异（6.79%；95%CI：-0.73 - 14.87%），但癌症检出率的合并差异显著，为33.49/10000（95%CI：23.88 - 43.10）。除了在接受DBT筛查的参与者中发生的间期BC更可能腋窝淋巴结转移阴性外（P = 0.005），两种筛查方式中间期BC预后特征的分布没有差异。