Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
Department of Biostatistics, Unit 1411, The University of Texas MD Anderson Cancer Center, PO Box 301402, Houston, TX, 77230-1402, USA.
Eur Radiol. 2021 Dec;31(12):9499-9510. doi: 10.1007/s00330-021-08040-3. Epub 2021 May 20.
Compare four groups being screened: women without breast implants undergoing digital mammography (DM), women without breast implants undergoing DM with digital breast tomosynthesis (DM/DBT), women with implants undergoing DM, and women with implants undergoing DM/DBT.
Mammograms from February 2011 to March 2017 were retrospectively reviewed after 13,201 were excluded for a unilateral implant or prior breast cancer. Patients had been allowed to choose between DM and DM/DBT screening. Mammography performance metrics were compared using chi-square tests.
Six thousand forty-one women with implants and 91,550 women without implants were included. In mammograms without implants, DM (n = 113,973) and DM/DBT (n = 61,896) yielded recall rates (RRs) of 8.53% and 6.79% (9726/113,973 and 4204/61,896, respectively, p < .001), cancer detection rates per 1000 exams (CDRs) of 3.96 and 5.12 (451/113,973 and 317/61,896, respectively, p = .003), and positive predictive values for recall (PPV1s) of 4.64% and 7.54% (451/9726 and 317/4204, respectively, p < .001), respectively. In mammograms with implants, DM (n = 6815) and DM/DBT (n = 5138) yielded RRs of 5.81% and 4.87% (396/6815 and 250/5138, respectively, p = .158), CDRs of 2.49 and 2.92 (17/6815 and 15/5138, respectively, p > 0.999), and PPV1s of 4.29% and 6.0% (17/396 and 15/250, respectively, p > 0.999), respectively.
DM/DBT significantly improved recall rates, cancer detection rates, and positive predictive values for recall compared to DM alone in women without implants. DM/DBT performance in women with implants trended towards similar improvements, though no metric was statistically significant.
• Digital mammography with tomosynthesis improved recall rates, cancer detection rates, and positive predictive values for recall compared to digital mammography alone for women without implants. • Digital mammography with tomosynthesis trended towards improving recall rates, cancer detection rates, and positive predictive values for recall compared to digital mammography alone for women with implants, but these trends were not statistically significant - likely related to sample size.
比较四个接受筛查的组：接受数字乳房 X 线摄影术（DM）检查的无乳房植入物的女性、接受 DM 加数字乳腺断层合成术（DM/DBT）检查的无乳房植入物的女性、接受 DM 检查的有乳房植入物的女性以及接受 DM/DBT 检查的有乳房植入物的女性。
对 2011 年 2 月至 2017 年 3 月的乳腺 X 光片进行回顾性研究，剔除了 13201 例单侧植入物或既往乳腺癌患者。患者可选择接受 DM 或 DM/DBT 筛查。使用卡方检验比较乳腺 X 光片的性能指标。
共纳入 6041 例有植入物的女性和 91550 例无植入物的女性。在无植入物的乳腺 X 光片中，DM（n=113973）和 DM/DBT（n=61896）的召回率（RR）分别为 8.53%和 6.79%（分别为 9726/113973 和 4204/61896，p<.001），每千次检查的癌症检出率（CDR）分别为 3.96 和 5.12（分别为 451/113973 和 317/61896，p=0.003），召回的阳性预测值（PPV1）分别为 4.64%和 7.54%（分别为 451/9726 和 317/4204，p<.001）。在有植入物的乳腺 X 光片中，DM（n=6815）和 DM/DBT（n=5138）的 RR 分别为 5.81%和 4.87%（分别为 396/6815 和 250/5138，p=0.158），CDR 分别为 2.49%和 2.92%（分别为 17/6815 和 15/5138，p>.999），PPV1 分别为 4.29%和 6.0%（分别为 17/396 和 15/250，p>.999）。
与单独使用 DM 相比，DM/DBT 可显著提高无植入物女性的召回率、癌症检出率和召回的阳性预测值。DM/DBT 在有植入物的女性中的表现趋势相似，但无任何指标具有统计学意义。
与单独使用数字乳房 X 线摄影术相比，数字乳房 X 线摄影术加断层合成术可提高无乳房植入物女性的召回率、癌症检出率和召回的阳性预测值。
与单独使用数字乳房 X 线摄影术相比，数字乳房 X 线摄影术加断层合成术在有乳房植入物的女性中提高召回率、癌症检出率和召回的阳性预测值的趋势，但这些趋势没有统计学意义，可能与样本量有关。
