Ambinder Emily B, Lee Emerson, Nguyen Derek L, Gong Anna J, Haken Orli J, Visvanathan Kala
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, 601 N. Caroline St., Baltimore, Maryland, 21287; Johns Hopkins Sidney Kimmel Cancer Center, Baltimore MD.
Johns Hopkins School of Medicine, Baltimore MD.
Acad Radiol. 2023 Sep;30 Suppl 2:S154-S160. doi: 10.1016/j.acra.2023.01.007. Epub 2023 Feb 3.
Mammographic screening detects most breast cancers but there are still women diagnosed with breast cancer between annual mammograms. We aim to identify features that differentiate screen detected breast cancers from interval breast cancer.
All screening mammograms (n = 211,517) performed 7/1/2013-6/30/2020 at our institution were reviewed. Patients with breast cancer diagnosed within one year of screening were included and divided into two distinct groups: screen detected cancer group and interval cancer group. Characteristics in these groups were compared using the chi square test, fisher test, and student's T test.
A total of 1,232 patients were included (mean age 64 +/- 11). Sensitivity of screening mammography was 92% (1,136 screen detected cancers, 96 interval cancers). Patient age, race, and personal history of breast cancer were similar between the groups (p > 0.05). Patients with interval cancers more often had dense breast tissue (75/96 = 78% versus 694/1136 = 61%, p < 0.001). Compared to screen detected cancers, interval cancers were more often primary tumor stage two or higher (41/96 = 43% versus 139/1136 = 12%, p < 0.001) and regional lymph node stage one or higher (21/96 = 22% versus 132/1136 = 12%, p = 0.003). Interval cancers were more often triple negative (16/77 = 21% versus [48/813 = 6%], p < 0.001) with high Ki67 proliferation indices (28/45 = 62% versus 188/492 = 38%, p = 0.002).
Mammographic screening had high sensitivity for breast cancer detection (92%). Interval cancers were associated with dense breast tissue and had higher stage with less favorable molecular features compared to screen detected cancers.
乳腺钼靶筛查可检测出大多数乳腺癌，但仍有女性在年度钼靶检查期间被诊断出患有乳腺癌。我们旨在确定能够区分筛查发现的乳腺癌与间期乳腺癌的特征。
回顾了2013年7月1日至2020年6月30日在本机构进行的所有筛查钼靶检查（n = 211,517）。纳入在筛查后一年内被诊断为乳腺癌的患者，并将其分为两个不同的组：筛查发现的癌症组和间期癌症组。使用卡方检验、费舍尔检验和学生t检验比较这些组的特征。
共纳入1232例患者（平均年龄64±11岁）。乳腺钼靶筛查的敏感性为92%（1136例筛查发现的癌症，96例间期癌症）。两组患者的年龄、种族和乳腺癌个人史相似（p>0.05）。间期癌症患者更常伴有致密乳腺组织（75/96 = 78% 对比 694/1136 = 61%，p<0.001）。与筛查发现的癌症相比，间期癌症更常为原发性肿瘤二期或更高期（41/96 = 43% 对比 139/1136 = 12%，p<0.001）以及区域淋巴结一期或更高期（21/96 = 22% 对比 1三百一十二/1136 = 12%，p = 0.003）。间期癌症更常为三阴性（16/77 = 21% 对比 [48/813 = 6%]，p<0.001），且Ki67增殖指数较高（28/45 = 62% 对比 188/492 = 38%，p = 0.002）。
乳腺钼靶筛查对乳腺癌检测具有高敏感性（92%）。与筛查发现的癌症相比，间期癌症与致密乳腺组织相关，且分期更高，分子特征更不理想。
