Vu Nhu Q, Bice Curran, Garrett John, Longhurst Colin, Belden Daryn, Haerr Carolyn, Prue Lucinda, Woods Ryan W
University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA.
UW Health, Department of Radiology, Madison, WI, USA.
J Breast Imaging. 2021 Nov 16;3(6):694-700. doi: 10.1093/jbi/wbab073.
To compare the mean glandular dose (MGD), cancer detection rate (CDR), and recall rate (RR) among screening examinations of patients with breast implants utilizing various digital breast tomosynthesis (DBT)-based imaging protocols.
This IRB-approved retrospective study included 1998 women with breast implants who presented for screening mammography between December 10, 2013, and May 29, 2020. Images were obtained using various protocol combinations of DBT and 2D digital mammography. Data collected included MGD, implant type and position, breast density, BI-RADS final assessment category, CDR, and RR. Statistical analysis utilized type II analysis of variance and the chi-square test.
The highest MGD was observed in the DBT only protocol, while the 2D only protocol had the lowest (10.29 mGy vs 5.88 mGy, respectively). Statistically significant difference in MGD was observed across protocols (P < 0.0001). The highest per-view MGD was among DBT full-field (FF) views in both craniocaudal and mediolateral oblique projections (P < 0.0001). No significant difference was observed in RR among protocols (P = 0.17). The combined 2D (FF only) + DBT implant-displaced (ID) views protocol detected the highest number of cancers (CDR, 7.2 per 1000), but this was not significantly different across protocols (P = 0.48).
The combination of 2D FF views and DBT ID views should be considered for women with breast implants in a DBT-based screening practice when aiming to minimize radiation exposure without compromising the sensitivity of cancer detection. Avoidance of DBT FF in this patient population is recommended to minimize radiation dose.
比较采用各种基于数字乳腺断层合成（DBT）的成像方案对植入乳房假体患者进行筛查时的平均腺体剂量（MGD）、癌症检出率（CDR）和召回率（RR）。
这项经机构审查委员会（IRB）批准的回顾性研究纳入了1998例植入乳房假体的女性，她们于2013年12月10日至2020年5月29日期间接受了乳腺钼靶筛查。使用DBT和二维数字乳腺摄影的各种方案组合获取图像。收集的数据包括MGD、假体类型和位置、乳腺密度、乳腺影像报告和数据系统（BI-RADS）最终评估类别、CDR和RR。统计分析采用II型方差分析和卡方检验。
仅使用DBT的方案中观察到最高的MGD，而仅使用二维的方案中MGD最低（分别为10.29 mGy和5.88 mGy）。各方案之间MGD存在统计学显著差异（P < 0.0001）。在头尾位和内外斜位投影中，DBT全场（FF）视图的每视图MGD最高（P < 0.0001）。各方案之间RR无显著差异（P = 0.17）。二维（仅FF）+ DBT假体移位（ID）视图的联合方案检测到的癌症数量最多（CDR，每1000人中有7.2例），但各方案之间无显著差异（P = 0.48）。
在基于DBT的筛查实践中，对于植入乳房假体的女性，若旨在在不影响癌症检测敏感性的情况下尽量减少辐射暴露，应考虑二维FF视图和DBT ID视图的组合。建议在该患者群体中避免使用DBT FF以尽量减少辐射剂量。
