Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
Korean J Radiol. 2023 Apr;24(4):274-283. doi: 10.3348/kjr.2022.0649.
To compare the outcomes of digital breast tomosynthesis (DBT) screening combined with ultrasound (US) with those of digital mammography (DM) combined with US in women with dense breasts.
A retrospective database search identified consecutive asymptomatic women with dense breasts who underwent breast cancer screening with DBT or DM and whole-breast US simultaneously between June 2016 and July 2019. Women who underwent DBT + US (DBT cohort) and DM + US (DM cohort) were matched using 1:2 ratio according to mammographic density, age, menopausal status, hormone replacement therapy, and a family history of breast cancer. The cancer detection rate (CDR) per 1000 screening examinations, abnormal interpretation rate (AIR), sensitivity, and specificity were compared.
A total of 863 women in the DBT cohort were matched with 1726 women in the DM cohort (median age, 53 years; interquartile range, 40-78 years) and 26 breast cancers (9 in the DBT cohort and 17 in the DM cohort) were identified. The DBT and DM cohorts showed comparable CDR (10.4 [9 of 863; 95% confidence interval {CI}: 4.8-19.7] vs. 9.8 [17 of 1726; 95% CI: 5.7-15.7] per 1000 examinations, respectively; = 0.889). DBT cohort showed a higher AIR than the DM cohort (31.6% [273 of 863; 95% CI: 28.5%-34.9%] vs. 22.4% [387 of 1726; 95% CI: 20.5%-24.5%]; < 0.001). The sensitivity for both cohorts was 100%. In women with negative findings on DBT or DM, supplemental US yielded similar CDRs in both DBT and DM cohorts (4.0 vs. 3.3 per 1000 examinations, respectively; = 0.803) and higher AIR in the DBT cohort (24.8% [188 of 758; 95% CI: 21.8%-28.0%] vs. 16.9% [257 of 1516; 95% CI: 15.1%-18.9%; < 0.001).
DBT screening combined with US showed comparable CDR but lower specificity than DM screening combined with US in women with dense breasts.
比较乳腺致密的女性行数字乳腺断层摄影术（DBT）联合超声（US）筛查与数字乳腺钼靶（DM）联合 US 筛查的结果。
回顾性数据库检索了 2016 年 6 月至 2019 年 7 月期间同时行 DBT 或 DM 联合全乳 US 筛查的连续无症状乳腺致密的女性。根据乳腺密度、年龄、绝经状态、激素替代疗法和乳腺癌家族史，对行 DBT+US（DBT 组）和 DM+US（DM 组）的女性进行 1:2 比例匹配。比较每 1000 例筛查检查的癌症检出率（CDR）、异常解读率（AIR）、敏感性和特异性。
DBT 组共 863 例患者与 DM 组 1726 例患者（中位年龄 53 岁；四分位间距 40-78 岁）相匹配，共发现 26 例乳腺癌（DBT 组 9 例，DM 组 17 例）。DBT 组和 DM 组的 CDR 相似（每 1000 例分别为 10.4[863 例中 9 例；95%置信区间{CI}：4.8-19.7]和 9.8[1726 例中 17 例；95%CI：5.7-15.7]；=0.889）。DBT 组的 AIR 高于 DM 组（31.6%[863 例中 273 例；95%CI：28.5%-34.9%]和 22.4%[1726 例中 387 例；95%CI：20.5%-24.5%]；<0.001）。两组的敏感性均为 100%。在 DBT 或 DM 检查结果为阴性的女性中，补充 US 在 DBT 和 DM 组的 CDR 相似（分别为 4.0 和 3.3 例/1000 例；=0.803），而 DBT 组的 AIR 更高（24.8%[758 例中 188 例；95%CI：21.8%-28.0%]和 16.9%[1516 例中 257 例；95%CI：15.1%-18.9%]；<0.001）。
在乳腺致密的女性中，DBT 联合 US 筛查的 CDR 与 DM 联合 US 筛查相似，但特异性低于 DM 联合 US 筛查。
