From the Department of Surgery, Office of Health Promotion Research, University of Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425, Burlington, VT 05405 (B.L.S.); Department of Radiology, University of Vermont Larner College of Medicine, Burlington, Vt (B.L.S., S.D.H., H.P.); University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, Vt (B.L.S., S.D.H., H.P., D.L.W.); Kaiser Permanente Washington Health Research Institute, Seattle, Wash (L.I., J.E., E.S.O., D.L.M.); Department of Radiology, University of Washington and Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., J.M.L.); Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, Calif (D.L.M.); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.); Department of Pathology & Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, Vt (D.L.W.); Departments of Medicine and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, Calif (K.K.); and Department of Veterans Affairs, General Internal Medicine Section, University of California San Francisco, San Francisco, Calif (K.K.).
Radiology. 2024 Aug;312(2):e232380. doi: 10.1148/radiol.232380.
Background It is unclear whether breast US screening outcomes for women with dense breasts vary with levels of breast cancer risk. Purpose To evaluate US screening outcomes for female patients with dense breasts and different estimated breast cancer risk levels. Materials and Methods This retrospective observational study used data from US screening examinations in female patients with heterogeneously or extremely dense breasts conducted from January 2014 to October 2020 at 24 radiology facilities within three Breast Cancer Surveillance Consortium (BCSC) registries. The primary outcomes were the cancer detection rate, false-positive biopsy recommendation rate, and positive predictive value of biopsies performed (PPV3). Risk classification of participants was performed using established BCSC risk prediction models of estimated 6-year advanced breast cancer risk and 5-year invasive breast cancer risk. Differences in high- versus low- or average-risk categories were assessed using a generalized linear model. Results In total, 34 791 US screening examinations from 26 489 female patients (mean age at screening, 53.9 years ± 9.0 [SD]) were included. The overall cancer detection rate per 1000 examinations was 2.0 (95% CI: 1.6, 2.4) and was higher in patients with high versus low or average risk of 6-year advanced breast cancer (5.5 [95% CI: 3.5, 8.6] vs 1.3 [95% CI: 1.0, 1.8], respectively; = .003). The overall false-positive biopsy recommendation rate per 1000 examinations was 29.6 (95% CI: 22.6, 38.6) and was higher in patients with high versus low or average 6-year advanced breast cancer risk (37.0 [95% CI: 28.2, 48.4] vs 28.1 [95% CI: 20.9, 37.8], respectively; = .04). The overall PPV3 was 6.9% (67 of 975; 95% CI: 5.3, 8.9) and was higher in patients with high versus low or average 6-year advanced cancer risk (15.0% [15 of 100; 95% CI: 9.9, 22.2] vs 4.9% [30 of 615; 95% CI: 3.3, 7.2]; = .01). Similar patterns in outcomes were observed by 5-year invasive breast cancer risk. Conclusion The cancer detection rate and PPV3 of supplemental US screening increased with the estimated risk of advanced and invasive breast cancer. © RSNA, 2024 See also the editorial by Helbich and Kapetas in this issue.
背景 目前尚不清楚致密型乳腺女性的乳腺超声筛查结果是否随乳腺癌风险水平的不同而有所差异。目的 旨在评估不同乳腺癌风险水平的致密型乳腺女性患者的乳腺超声筛查结果。材料与方法 本回顾性观察性研究使用了 2014 年 1 月至 2020 年 10 月在三个乳腺癌监测协作组（BCSC）注册中心内的 24 个放射科进行的乳腺不均匀或极高密度女性患者的乳腺 US 筛查检查数据。主要结局指标为癌症检出率、假阳性活检推荐率和活检的阳性预测值（PPV3）。采用既定的 BCSC 风险预测模型对参与者进行风险分类，预测 6 年高级别乳腺癌风险和 5 年浸润性乳腺癌风险。使用广义线性模型评估高风险与低风险或平均风险类别的差异。结果 共纳入了 34791 次 US 筛查检查，来自 26489 名女性患者（筛查时平均年龄为 53.9 岁±9.0[标准差]）。每 1000 次检查的总体癌症检出率为 2.0（95%CI：1.6，2.4），高风险与低风险或平均风险（6 年高级别乳腺癌风险）相比，癌症检出率更高，分别为 5.5（95%CI：3.5，8.6）和 1.3（95%CI：1.0，1.8）（ =.003）。每 1000 次检查的总体假阳性活检推荐率为 29.6（95%CI：22.6，38.6），高风险与低风险或平均风险（6 年高级别乳腺癌风险）相比，假阳性活检推荐率更高，分别为 37.0（95%CI：28.2，48.4）和 28.1（95%CI：20.9，37.8）（ =.04）。总的 PPV3 为 6.9%（975 例中有 67 例；95%CI：5.3，8.9），高风险与低风险或平均风险（6 年高级别乳腺癌风险）相比，PPV3 更高，分别为 15.0%（100 例中有 15 例；95%CI：9.9，22.2）和 4.9%（615 例中有 30 例；95%CI：3.3，7.2）（ =.01）。按 5 年浸润性乳腺癌风险评估，也观察到了类似的结果模式。结论 随着高级别和浸润性乳腺癌风险的估计增加，补充性乳腺超声筛查的癌症检出率和 PPV3 也随之提高。©RSNA，2024 参见本期 Helbich 和 Kapetas 的社论。
