Sommer Alexander, Weigel Stefanie, Hense Hans-Werner, Gerß Joachim, Weyer-Elberich Veronika, Kerschke Laura, Nekolla Elke, Lenzen Horst, Heindel Walter
Clinic for Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany.
Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany.
Eur Radiol. 2025 Jan;35(1):166-176. doi: 10.1007/s00330-024-10847-9. Epub 2024 Jul 16.
The randomized TOmosynthesis plus SYnthesized MAmmography (TOSYMA) screening trial has shown that digital breast tomosynthesis plus synthesized mammography (DBT + SM) is superior to digital mammography (DM) in invasive breast cancer detection varying with breast density. On the other hand, the overall average glandular dose (AGD) of DBT is higher than that of DM. Comparing the DBT + SM and DM trial arm, we analyzed here the mean AGD and their determinants per breast density category and related them to the respective invasive cancer detection rates (iCDR).
TOSYMA screened 99,689 women aged 50 to 69 years. Compression force, resulting breast thickness, the calculated AGD obtained from each mammography device, and previously published iCDR were used for comparisons across breast density categories in the two trial arms.
There were 196,622 exposures of 49,227 women (DBT + SM) and 197,037 exposures of 49,132 women (DM) available for analyses. Mean breast thicknesses declined from breast density category A (fatty) to D (extremely dense) in both trial arms. However, while the mean AGD in the DBT + SM arm declined concomitantly from category A (2.41 mGy) to D (1.89 mGy), it remained almost unchanged in the DM arm (1.46 and 1.51 mGy, respectively). In relative terms, the AGD elevation in the DBT + SM arm (64.4% (A), by 44.5% (B), 27.8% (C), and 26.0% (D)) was lowest in dense breasts where, however, the highest iCDR were observed.
Women with dense breasts may specifically benefit from DBT + SM screening as high cancer detection is achieved with only moderate AGD elevations.
TOSYMA suggests a favorable constellation for screening with digital breast tomosynthesis plus synthesized mammography (DBT + SM) in dense breasts when weighing average glandular dose elevation against raised invasive breast cancer detection rates. There is potential for density-, i.e., risk-adapted population-wide breast cancer screening with DBT + SM.
Breast thickness declines with visually increasing density in digital mammography (DM) and digital breast tomosynthesis (DBT). Average glandular doses of DBT decrease with increasing density; digital mammography shows lower and more constant values. With the smallest average glandular dose difference in dense breasts, DBT plus SM had the highest difference in invasive breast cancer detection rates.
随机化乳腺断层合成加合成乳腺摄影（TOSYMA）筛查试验表明，数字乳腺断层合成加合成乳腺摄影（DBT + SM）在检测浸润性乳腺癌方面优于数字乳腺摄影（DM），且随乳腺密度而异。另一方面，DBT的总体平均腺体剂量（AGD）高于DM。比较DBT + SM和DM试验组，我们在此分析了每个乳腺密度类别下的平均AGD及其决定因素，并将它们与各自的浸润性癌症检测率（iCDR）相关联。
TOSYMA对99689名年龄在50至69岁的女性进行了筛查。使用压迫力、由此产生的乳房厚度、从每个乳腺摄影设备获得的计算出的AGD以及先前公布的iCDR，对两个试验组中的乳腺密度类别进行比较。
有49227名女性的196622次曝光（DBT + SM）和49132名女性的197037次曝光（DM）可用于分析。在两个试验组中，平均乳房厚度从乳腺密度类别A（脂肪型）到D（极度致密型）均呈下降趋势。然而，虽然DBT + SM组的平均AGD从A类（2.41 mGy）到D类（1.89 mGy）随之下降，但DM组的平均AGD几乎保持不变（分别为1.46和1.51 mGy）。相对而言，DBT + SM组的AGD升高幅度（A类为64.4%，B类为44.5%，C类为27.8%，D类为26.0%）在致密乳房中最低，而致密乳房中观察到的iCDR最高。
致密乳房的女性可能特别受益于DBT + SM筛查，因为在仅适度升高AGD的情况下就能实现高癌症检测率。
TOSYMA表明，在权衡平均腺体剂量升高与浸润性乳腺癌检测率提高时，数字乳腺断层合成加合成乳腺摄影（DBT + SM）对致密乳房进行筛查具有良好的组合优势。存在采用DBT + SM进行密度适应性（即风险适应性）全人群乳腺癌筛查的潜力。
在数字乳腺摄影（DM）和数字乳腺断层合成（DBT）中，乳房厚度随视觉上密度的增加而下降。DBT的平均腺体剂量随密度增加而降低；数字乳腺摄影显示的值较低且更恒定。在致密乳房中平均腺体剂量差异最小的情况下，DBT加SM在浸润性乳腺癌检测率方面的差异最大。
