Department of Radiology, Elsan, Centre République, 99 avenue de la République, BP 304, 63023, Clermont-Ferrand Cedex 2, France.
Department of Radiology, Centre Hospitalier Universitaire de Montréal, 1051 Rue Sanguinet, Montréal, QC, H2X 3H4, Canada.
Eur Radiol. 2021 Dec;31(12):9529-9539. doi: 10.1007/s00330-021-07999-3. Epub 2021 May 28.
Breast cancer screening consists of batch interpretation of two-view (cranio-caudal CC- and medio-lateral oblique MLO) digital mammography (DM) per breast. The DM-MLO view was substituted by an MLO-digital breast tomosynthesis (DBT) and its synthetic (2D-synthetic mammography (SM)-MLO) view. The performance of this hybrid protocol was evaluated in a one-stop-shop screening visit, providing immediate reading and additional work up.
Retrospective, observational review, comparing the cancer detection rate (CDR), breast US rates, and biopsy rates in 13,048 women screened with DM from June 2015 to November 2016 and 8639 women screened with SM-DBT/DM from January 2017 to July 2018. Chi-square tests or Fisher's exact tests were used to compare proportions between the two screening imaging methods.
SM + DBT/DM significantly increased the overall CDR (10.8‰) versus DM (7.5‰) (p = 0.0120) with more invasive lobular carcinoma (14% versus 4%) (p = 0.0357) detected and overall more invasive cancers among women with breast density type B (p = 0.0411) and those aged between 60 and 70 (p = 0.0306). This was achieved at the expense of additional sonographic examinations performed (33.5% in DBT group versus 26.7% in DM group) (p < 0.0001), more BI-RADS category III assigned (1.8% in SM-DBT/DM group versus 1.5% in DM group) (p = 0.0443) and more biopsy rates (3.0 % in SM-DBT/DM group versus 1.7% in DM group) (p < 0.0001).
Hybrid mammographic protocol replacing 2D-MLO by DBT-MLO and SM-MLO views in a one-stop-shop screening visit improved CDR, at the expense of more sonographic examinations, biopsies, and BI-RADS III lesions. Breast US alone detected 9.2% of all breast cancers in this cohort.
• Hybrid protocol including MLO (DBT + SM) with 2D DM CC may improve CDR compared to standard 4 views 2D DM in a screening program providing immediate interpretation. • Adding screening breast US, when perceived necessary, in the same visit of a screening mammography, increases cancer detection rate of 9.2%. • Based on our results, hybrid protocol including DBT + SM in MLO plane and DM in CC plane could be safely implemented as a transition towards DBT and SM alone, without any compromise in the cancer detection ability. Our results may vary according to the properties of machines from different vendors.
乳腺癌筛查包括对每侧乳房进行两次视图（头尾向 CC 和内外斜向 MLO）数字乳腺摄影术（DM）的批量解读。DM-MLO 视图被 MLO-数字乳腺断层合成术（DBT）及其合成视图（2D 合成乳腺 X 线摄影术（SM）-MLO）取代。在一次一站式筛查就诊中，评估了这种混合方案的性能，提供了即时阅读和额外的检查。
回顾性观察性研究，比较了 2015 年 6 月至 2016 年 11 月期间接受 DM 筛查的 13048 名女性和 2017 年 1 月至 2018 年 7 月期间接受 SM-DBT/DM 筛查的 8639 名女性的癌症检出率（CDR）、乳腺超声检查率和活检率。使用卡方检验或 Fisher 确切概率法比较两种筛查成像方法之间的比例。
SM+DBT/DM 与 DM 相比，总体 CDR（10.8‰）显著增加（p = 0.0120），检测到更多浸润性小叶癌（14%对 4%）（p = 0.0357），并且在乳腺密度 B 型的女性（p = 0.0411）和 60-70 岁的女性（p = 0.0306）中总体更多的浸润性癌症。这是通过增加超声检查（DBT 组 33.5%，DM 组 26.7%）（p<0.0001）、更多 BI-RADS 分类 3 类（SM-DBT/DM 组 1.8%，DM 组 1.5%）（p = 0.0443）和更多活检率（SM-DBT/DM 组 3.0%，DM 组 1.7%）（p<0.0001）来实现的。
在一站式筛查就诊中，混合乳腺摄影方案用 DBT-MLO 和 SM-MLO 视图替代二维 MLO 视图，提高了 CDR，但增加了超声检查、活检和 BI-RADS III 病变的数量。在该队列中，单独的乳腺超声检查发现了 9.2%的所有乳腺癌。
与标准的 4 视图 2D DM 相比，包括 MLO（DBT+SM）和 2D DM CC 的混合方案可能会提高筛查方案的 CDR，同时可提供即时解读。
在筛查乳腺 X 线摄影的同一就诊中添加筛查性乳腺超声检查，如果认为有必要，可以提高 9.2%的癌症检出率。
基于我们的结果，包括 MLO 平面 DBT+SM 和 CC 平面 DM 的混合方案可以安全地实施，作为向 DBT 和 SM 单独过渡的一种方式，而不会影响癌症检出能力。我们的结果可能因不同供应商的机器特性而异。
