School of Medicine, Department of Radiology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
Department of Radiology, Acibadem Altunizade Hospital, Istanbul, Turkey.
Int J Cancer. 2024 Oct 15;155(8):1466-1475. doi: 10.1002/ijc.35093. Epub 2024 Jul 11.
We aimed to determine the value of standalone and supplemental automated breast ultrasound (ABUS) in detecting cancers in an opportunistic screening setting with digital breast tomosynthesis (DBT) and compare this combined screening method to DBT and ABUS alone in women older than 39 years with BI-RADS B-D density categories. In this prospective opportunistic screening study, 3466 women aged 39 or older with BI-RADS B-D density categories and with a mean age of 50 were included. The screening protocol consisted of DBT mediolateral-oblique views, 2D craniocaudal views, and ABUS with three projections for both breasts. ABUS was evaluated blinded to mammography findings. Statistical analysis evaluated diagnostic performance for DBT, ABUS, and combined workflows. Twenty-nine cancers were screen-detected. ABUS and DBT exhibited the same cancer detection rates (CDR) at 7.5/1000 whereas DBT + ABUS showed 8.4/1000, with ABUS contributing an additional CDR of 0.9/1000. Standalone ABUS outperformed DBT in detecting 12.5% more invasive cancers. DBT displayed better accuracy (95%) compared to ABUS (88%) and combined approach (86%). Sensitivities for DBT and ABUS were the same (84%), with DBT + ABUS showing a higher rate (94%). DBT outperformed ABUS in specificity (95% vs. 88%). DBT + ABUS exhibited a higher recall rate (14.89%) compared to ABUS (12.38%) and DBT (6.03%) (p < .001). Standalone ABUS detected more invasive cancers compared to DBT, with a higher recall rate. The combined approach showed a higher CDR by detecting one additional cancer per thousand.
我们旨在确定在数字乳腺断层摄影术（DBT）的机会性筛查设置中，独立和补充自动乳腺超声（ABUS）在检测癌症方面的价值，并将这种联合筛查方法与单独使用 DBT 和 ABUS 进行比较，比较对象为 BI-RADS B-D 密度类别的 39 岁以上女性。在这项前瞻性机会性筛查研究中，纳入了 3466 名 BI-RADS B-D 密度类别且年龄在 39 岁或以上、平均年龄为 50 岁的女性。筛查方案包括 DBT 斜位侧位、2D 头尾位和双侧乳房的 3 个投影的 ABUS。ABUS 的评估是盲于 mammography 结果的。统计分析评估了 DBT、ABUS 和联合工作流程的诊断性能。共发现 29 例癌。ABUS 和 DBT 的癌症检出率（CDR）相同，为 7.5/1000，而 DBT+ABUS 为 8.4/1000，ABUS 额外增加了 0.9/1000 的 CDR。单独的 ABUS 在检测浸润性癌方面的表现优于 DBT，检出率提高了 12.5%。DBT 的准确率（95%）优于 ABUS（88%）和联合方法（86%）。DBT 和 ABUS 的敏感性相同（84%），而 DBT+ABUS 的敏感性更高（94%）。DBT 在特异性方面优于 ABUS（95%对 88%）。DBT+ABUS 的召回率（14.89%）高于 ABUS（12.38%）和 DBT（6.03%）（p<0.001）。单独的 ABUS 比 DBT 检测到更多的浸润性癌，且召回率更高。联合方法通过每千例检测到额外的 1 例癌症，显示出更高的 CDR。
