Rao Amshuman, Elder Elisabeth, Center Jacqueline R, Tran Thach, Pocock Nicholas, Elder Grahame J
University of Notre Dame Australia School of Medicine Sydney NSW Australia.
Westmead Breast Cancer Institute Westmead NSW Australia.
JBMR Plus. 2022 Mar 21;6(5):e10618. doi: 10.1002/jbm4.10618. eCollection 2022 May.
Fracture risk evaluation of postmenopausal women is suboptimal, but most women undergo screening mammography. Digital X-radiogrammetry (DXR) determines bone mineral density (BMD) at the metacarpal shaft and can be performed on mammography equipment. This study examined correlations between DXR and dual-energy X-ray absorptiometry (DXA) in women undergoing mammography, to identify optimal DXR thresholds for triage to osteoporosis screening by central DXA. Postmenopausal women over age 50 years, recruited from Westmead Hospital's Breast Cancer Institute, underwent mammography, DXR and DXA. Agreements were determined using the area under the receiver operator characteristic (AUC ROC) curve and Lin's concordance correlation coefficient. Optimal DXR -scores to exclude osteoporosis by DXA were determined using the Youden's method. Of 200 women aged 64 ± 7 years (mean ± standard deviation [SD]), 82% had been diagnosed with breast cancer and 37% reported prior fracture. DXA -scores were ≤ -1 at the spine, hip or forearm in 77.5% and accorded with DXR -scores in 77%. For DXR and DXA -scores ≤ -2.5, the AUC ROC was 0.87 (95% confidence interval [CI], 0.81-0.94) at the 1/3 radius, and 0.74 (95% CI, 0.64-0.84) for hip or spine. DXR -scores > -1.98 provided a negative predictive value of 94% (range, 88%, 98%) for osteoporosis by central DXA. In response to a questionnaire, radiography staff responded that DXR added 5 minutes to patient throughput with minimal workflow impact. In the mammography setting, triaging women with a screening DXR -score < -1.98 for DXA evaluation would capture a significant proportion of at-risk women who may not otherwise be identified and improve current low rates of osteoporosis screening. © 2022 The Authors. published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
绝经后女性的骨折风险评估并不理想，但大多数女性会接受乳腺钼靶筛查。数字X线骨密度测量法（DXR）可测定掌骨干的骨密度，且能在乳腺钼靶设备上进行。本研究检测了接受乳腺钼靶检查的女性中DXR与双能X线吸收法（DXA）之间的相关性，以确定用于分诊至通过中心DXA进行骨质疏松症筛查的最佳DXR阈值。从韦斯特米德医院乳腺癌研究所招募的50岁以上绝经后女性接受了乳腺钼靶检查、DXR和DXA。使用受试者工作特征曲线下面积（AUC ROC）和林氏一致性相关系数来确定一致性。采用尤登法确定排除DXA诊断为骨质疏松症的最佳DXR评分。在200名年龄为64±7岁（均值±标准差[SD]）的女性中，82%被诊断患有乳腺癌，37%报告有既往骨折史。77.5%的女性脊柱、髋部或前臂的DXA评分≤-1，且77%与DXR评分一致。对于DXR和DXA评分≤-2.5，在1/3桡骨处AUC ROC为0.87（95%置信区间[CI]，0.81-0.94），髋部或脊柱处为0.74（95%CI，0.64-0.84）。DXR评分＞-1.98时，中心DXA诊断骨质疏松症的阴性预测值为94%（范围，88%，98%）。根据一份调查问卷，放射科工作人员回复称，DXR使患者检查通量增加了5分钟，对工作流程影响最小。在乳腺钼靶检查中，将筛查DXR评分＜-1.98的女性分诊至DXA评估，将筛查出很大一部分可能未被识别的高危女性，并提高目前较低的骨质疏松症筛查率。©2022作者。由Wiley Periodicals LLC代表美国骨与矿物质研究学会出版。
