常规实践中的乳腺 X 光筛查：数字乳腺断层合成术和数字乳腺 X 光筛查的多地点研究。
Mammographic Screening in Routine Practice: Multisite Study of Digital Breast Tomosynthesis and Digital Mammography Screenings.
机构信息
From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (E.F.C.); Sanford Health, Sioux Falls, SD (M.M.T.); Solis Mammography, Houston, Tex (C.R.P.); Sutter Health, Fremont, Calif (B.C.S.); Sutter Health, Palo Alto, Calif (S.Y.L.); Hologic, Marlborough, Mass (S.P., A.R.); OM1, Boston, Mass (Y.J., L.A.S.S., J.K.P.); and Department of Radiology, Advocate Caldwell Breast Center, Park Ridge, Ill (N.A.).
出版信息
Radiology. 2023 May;307(3):e221571. doi: 10.1148/radiol.221571. Epub 2023 Mar 14.
Background The use of digital breast tomosynthesis (DBT) is increasing over digital mammography (DM) following studies demonstrating lower recall rates (RRs) and higher cancer detection rates (CDRs). However, inconsistent interpretation of evidence on the risks and benefits of mammography has resulted in varying screening mammography recommendations. Purpose To evaluate screening outcomes among women in the United States who underwent routine DM or DBT mammographic screening. Materials and Methods This retrospective cohort study included women aged 40-79 years who underwent DM or DBT screening mammograms between January 2014 and December 2020. Outcomes of RR, CDR, positive predictive value of recall (PPV1), biopsy rate, and positive predictive value of biopsy (PPV3) were compared between DM and DBT with use of adjusted multivariable logistic regression models. Results A total of 2 528 063 screening mammograms from 1 100 447 women (mean age, 57 years ± 10 [SD]) were included. In crude analyses, DBT (1 693 727 screening mammograms vs 834 336 DM screening mammograms) demonstrated lower RR (10.3% [95% CI: 10.3, 10.4] for DM vs 8.9% [95% CI: 8.9, 9.0] for DBT; < .001) and higher CDR (4.5 of 1000 screening mammograms [95% CI: 4.3, 4.6] vs 5.3 of 1000 [95% CI: 5.2, 5.5]; < .001), PPV1 (4.3% [95% CI: 4.2, 4.5] vs 5.9% [95% CI: 5.7, 6.0]; < .001), and biopsy rates (14.5 of 1000 screening mammograms [95% CI: 14.2, 14.7] vs 17.6 of 1000 [95% CI: 17.4, 17.8]; < .001). PPV3 was similar between cohorts (30.0% [95% CI: 29.2, 30.9] for DM vs 29.3% [95% CI: 28.7, 29.9] for DBT; = .16). After adjustment for age, breast density, site, and index year, associations remained stable with respect to statistical significance. Conclusion Women undergoing digital breast tomosynthesis had improved screening mammography outcomes compared with women who underwent digital mammography. © RSNA, 2023 See also the editorial by Bae and Seo in this issue.
背景 与数字乳腺摄影术（DM）相比，数字乳腺断层合成术（DBT）的应用正在增加，这是因为研究表明 DBT 的召回率（RR）较低，癌症检出率（CDR）较高。然而，由于对乳腺摄影术的风险和益处的证据存在不一致的解释，导致了不同的筛查乳腺摄影术建议。目的 评估在美国接受常规 DM 或 DBT 乳腺筛查的女性的筛查结果。材料与方法 本回顾性队列研究纳入了年龄在 40-79 岁之间、2014 年 1 月至 2020 年 12 月期间接受 DM 或 DBT 筛查性乳腺 X 线摄影的女性。使用调整后的多变量逻辑回归模型比较 DM 和 DBT 之间 RR、CDR、召回阳性预测值（PPV1）、活检率和活检阳性预测值（PPV3）的差异。结果 共纳入 1100447 名女性的 2528063 份筛查性乳腺 X 线摄影检查（平均年龄 57 岁±10[标准差]）。在粗分析中，DBT（1693727 份筛查性乳腺 X 线摄影检查 vs 834336 份 DM 筛查性乳腺 X 线摄影检查）的 RR 较低（DM 为 10.3%[95%CI：10.3，10.4]，DBT 为 8.9%[95%CI：8.9，9.0]；<.001），CDR 较高（每 1000 次筛查性乳腺 X 线摄影检查的 4.5 例[95%CI：4.3，4.6] vs 5.3 例[95%CI：5.2，5.5]；<.001），PPV1 较高（4.3%[95%CI：4.2，4.5] vs 5.9%[95%CI：5.7，6.0]；<.001），活检率较高（每 1000 次筛查性乳腺 X 线摄影检查的 14.5 例[95%CI：14.2，14.7] vs 17.6 例[95%CI：17.4，17.8]；<.001）。DM 组和 DBT 组的 PPV3 相似（DM 为 30.0%[95%CI：29.2，30.9]，DBT 为 29.3%[95%CI：28.7，29.9]；=.16）。在调整年龄、乳腺密度、部位和索引年后，统计学意义仍保持稳定。结论 与接受 DM 检查的女性相比，接受 DBT 检查的女性的乳腺筛查结果得到改善。©RSNA，2023 也可参见本期 Bae 和 Seo 的社论。
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