Li Tong, Lockie Darren, Clemson Michelle, Houssami Nehmat
The Daffodil Centre, the University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia.
Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
J Med Imaging Radiat Oncol. 2023 Apr;67(3):242-251. doi: 10.1111/1754-9485.13452. Epub 2022 Jun 29.
Australia's first population-based pilot trial comparing digital breast tomosynthesis (DBT) and digital mammography (DM) screening reported detection measures in 2019. This study describes the trial's secondary outcomes pertaining to the assessment process in women screened with DBT or DM, including the type of recalled abnormalities and the procedures performed.
Women with suspected abnormalities at screening were recalled for further investigation. Outcome measures were number of lesions assessed, types of imaging findings recalled to assessment, and data on testing and assessment outcomes; these were reported using descriptive analyses of lesion-specific data.
A total of 274 lesions and 203 lesions were reported in the DBT-screened and DM-screened groups, respectively. There were a higher proportion of lesions depicted as calcifications (32.4% vs 21.3%), and a lower proportion of lesions depicted as asymmetrical densities (3.2% vs 15.7%) for DBT recalls than DM recalls. A lower proportion of DBT-recalled lesions was assessed with additional mammography than DM-recalled lesions (49.3% vs 93.1%). Higher proportions of DBT-recalled lesions than DM-recalled lesions were investigated with clinical breast examination (50.4% vs 39.9%), core needle biopsy (45.6% vs 28.6%) and open biopsy (4.0% vs 1.0%). Similar proportions of DBT- and DM-recalled lesions were assessed using ultrasound (76.3% vs 71.4%).
Assessment of screen-recalled lesions showed that, compared with DM, DBT found more benign and more malignant lesions, and generally required more procedures except for less additional mammography workup. These findings show that a transition to DBT screening changes the assessment workload.
澳大利亚首次基于人群的比较数字乳腺断层合成（DBT）和数字乳腺钼靶（DM）筛查的试点试验于2019年报告了检测措施。本研究描述了该试验与接受DBT或DM筛查的女性评估过程相关的次要结果，包括召回异常的类型和所进行的程序。
筛查时有疑似异常的女性被召回做进一步检查。结果指标为评估的病变数量、召回评估的影像学发现类型以及检测和评估结果数据；这些通过对病变特异性数据的描述性分析进行报告。
DBT筛查组和DM筛查组分别报告了274个病变和203个病变。与DM召回相比，DBT召回的病变中，被描述为钙化的比例更高（32.4%对21.3%），被描述为不对称密度的比例更低（3.2%对15.7%）。与DM召回的病变相比，接受额外乳腺钼靶检查的DBT召回病变比例更低（49.3%对93.1%）。与DM召回的病变相比，接受临床乳腺检查（50.4%对39.9%）、粗针活检（45.6%对28.6%）和开放活检（4.0%对1.0%）的DBT召回病变比例更高。使用超声评估的DBT和DM召回病变比例相似（76.3%对71.4%）。
对筛查召回病变的评估表明，与DM相比，DBT发现了更多的良性和恶性病变，除了更少的额外乳腺钼靶检查外，通常需要更多的程序。这些发现表明，向DBT筛查的转变改变了评估工作量。
