The Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia.
Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council New South Wales, Sydney, NSW, Australia.
Ann Surg Oncol. 2024 Oct;31(10):6820-6830. doi: 10.1245/s10434-024-15848-y. Epub 2024 Jul 24.
BreastScreen Australia, the population mammographic screening program for breast cancer, uses two-view digital screening mammography ± ultrasound followed by percutaneous biopsy to detect breast cancer. Secondary breast imaging for further local staging, not performed at BreastScreen, may identify additional clinically significant breast lesions. Staging options include further mammography, bilateral ultrasound, and/or contrast-based imaging (CBI) [magnetic resonance imaging (MRI) or contrast-enhanced mammography (CEM)]. CBI for local staging of screen-detected cancer was introduced at an academic hospital breast service in Melbourne, VIC, Australia. We report findings for otherwise occult disease and resulting treatment changes.
Patients staged using CEM between November 2018 and April 2022 were identified from hospital records. Data were extracted from radiology, pathology, and breast unit databases. CEM-detected abnormalities were documented as true positive (TP) for invasive cancer or ductal carcinoma in situ (DCIS), or otherwise false positive (FP). The impact on surgical decisions was assessed.
Of 202 patients aged 44-84 years, 60 (30%) had 74 additional findings [34 (46%) TP, 40 (54%) FP]. These were malignant in 29/202 (14%) patients (79% invasive cancers, 21% DCIS). CEM resulted in surgical changes in 43/202 (21%) patients: wider resection (24/43), conversion to mastectomy (6/43), contralateral breast surgery (6/43), additional ipsilateral excision (5/43), and bracketing (2/43). Additional findings were more common for patients with larger index lesions and for invasive cancer, but there was no significant variation by age, breast density, or index lesion grade.
CEM for local staging of screen-detected breast cancers identified occult malignancy in 14% of patients. CEM improves local staging and may facilitate appropriate management of screen-detected breast cancers.
澳大利亚的乳腺癌人群筛查项目“BreastScreen Australia”采用双视图数字筛查乳房 X 光摄影术±超声检查，随后进行经皮活检，以检测乳腺癌。在“BreastScreen”之外进行的二次乳房影像学检查，用于进一步局部分期，可能会发现更多具有临床意义的乳房病变。分期选择包括进一步进行乳房 X 光摄影术、双侧超声检查和/或对比增强成像（CBI）[磁共振成像（MRI）或对比增强乳房 X 光摄影术（CEM）]。CEM 用于澳大利亚墨尔本一家学术医院乳腺科筛查发现的乳腺癌的局部分期，我们报告了隐匿性疾病的发现结果及其治疗改变。
从医院记录中确定了 2018 年 11 月至 2022 年 4 月期间使用 CEM 进行分期的患者。从放射学、病理学和乳腺科数据库中提取数据。记录 CEM 检测到的异常为浸润性癌或导管原位癌（DCIS）的真阳性（TP），或其他假阳性（FP）。评估了对手术决策的影响。
在 202 名年龄在 44-84 岁的患者中，60 名（30%）有 74 个额外发现[34 名（46%）TP，40 名（54%）FP]。这 202 名患者中有 29 名（14%）患者的恶性肿瘤为阳性（79%为浸润性癌，21%为 DCIS）。CEM 导致 202 名患者中的 43 名（21%）患者进行了手术改变：更广泛的切除（24/43）、转为乳房切除术（6/43）、对侧乳房手术（6/43）、同侧切除（5/43），以及定位（2/43）。对于指数病变较大的患者和浸润性癌患者，CEM 发现了更多隐匿性病变，但年龄、乳房密度或指数病变分级无显著差异。
CEM 用于筛查发现的乳腺癌的局部分期，在 14%的患者中发现隐匿性恶性肿瘤。CEM 提高了局部分期，并可能有助于对筛查发现的乳腺癌进行适当管理。
