From the Department of Radiology and Biomedical Imaging (L.E.P., L.J.H., L.S., M.E.) and Yale Physician Associate Program, Internal Medicine (J.K.G., M.Y.G.), Yale School of Medicine, Yale University, 333 Cedar St, New Haven, CT 06520.
Radiology. 2024 Sep;312(3):e232841. doi: 10.1148/radiol.232841.
Background Digital breast tomosynthesis (DBT) has been shown to help increase cancer detection compared with two-dimensional digital mammography (DM). However, it is unclear whether additional tumor detection will improve outcomes or lead to overdiagnosis of breast cancer. Purpose This study aimed to compare cancer types and stages over 3 years of DM screening and 10 years of DBT screening to determine the effect of DBT. Materials and Methods A retrospective search identified breast cancers detected by using screening mammography from August 2008 through July 2021. Data collected included demographic, imaging, and pathologic information. Invasive cancers 2 cm or larger, human epidermal growth factor 2-positive or triple-negative tumors greater than 10 mm, axillary nodes positive for cancer, and distant organ spread were considered advanced cancers. The DBT and DM cohorts were compared and further analyzed by prevalent versus incident examinations. False-negative findings were also assessed. Results A total of 1407 breast cancers were analyzed (142 with DM, 1265 with DBT). DBT showed a higher rate of cancer depiction than DM (5.3 vs four cancers per 1000, respectively; = .001), with a similar ratio of invasive cancers to ductal carcinomas in situ (76.5%:23.5% [968 and 297 of 1265, respectively] vs 71.1%:28.9% [101 and 41 of 142, respectively]). Mean invasive cancer size did not differ between DM and DBT (1.44 cm ± 0.93 [SD] vs 1.36 cm ± 1.14, respectively; = .49), but incident DBT cases were smaller than prevalent cases (1.2 cm ± 1.0 vs 1.6 cm ± 1.4, respectively; < .001). DBT and DM had similar rates of invasive cancer subtypes: low grade (26.5% [243 of 912] vs 29% [28 of 96], respectively), moderate grade (57.2% [522 of 912] vs 51% [49 of 96], respectively), and high grade (16.1% [147 of 912] vs 20% [19 of 96], respectively) ( = .65). The proportion of advanced cancers was lower with DBT than DM (32.6% [316 of 968] vs 43.6% [44 of 101], respectively; = .04) and between DBT prevalent and incident screening (39.1% [133 of 340] vs 29.1% [183 of 628], respectively; = .003). There was no difference in interval cancer rates (0.14 per 1000 with DM and 0.2 per 1000 with DBT; = .42) for both groups. Conclusion DBT helped to increase breast cancer detection rate and depicted invasive cancers with a lower rate of advanced cancers compared with DM, with further improvement observed at incident rounds of screening. © RSNA, 2024 See also the editorial by Kim and Woo in this issue.
背景 与二维数字乳腺摄影术（DM）相比，数字乳腺断层融合摄影术（DBT）已被证明有助于提高癌症检出率。然而，尚不清楚额外的肿瘤检出是否会改善结果或导致乳腺癌的过度诊断。
目的 本研究旨在比较 DM 筛查 3 年和 DBT 筛查 10 年期间的乳腺癌类型和分期，以确定 DBT 的效果。
材料与方法 回顾性搜索确定了 2008 年 8 月至 2021 年 7 月期间通过筛查性乳房 X 线摄影术检出的乳腺癌。收集的数据包括人口统计学、影像学和病理学信息。2 cm 或更大的浸润性癌、人表皮生长因子 2 阳性或三阴性肿瘤大于 10 mm、腋窝淋巴结阳性癌症和远处器官转移被认为是晚期癌症。比较了 DBT 和 DM 队列，并通过现患与新发检查进一步分析。还评估了假阴性结果。
结果 共分析了 1407 例乳腺癌（DM 组 142 例，DBT 组 1265 例）。DBT 的癌症检出率高于 DM（每 1000 例分别为 5.3 例和 4 例癌症； <.001），浸润性癌与导管原位癌的比例相似（76.5%：23.5%[968 例与 297 例，分别]与 71.1%：28.9%[101 例与 41 例，分别]）。DM 和 DBT 之间的浸润性癌平均大小无差异（1.44 cm ± 0.93 [SD]与 1.36 cm ± 1.14，分别； =.49），但新发 DBT 病例比现患病例小（1.2 cm ± 1.0 与 1.6 cm ± 1.4，分别； <.001）。DBT 和 DM 的浸润性癌亚型比例相似：低级别（26.5%[912 例中的 243 例]与 29%[96 例中的 28 例]，分别）、中级别（57.2%[912 例中的 522 例]与 51%[96 例中的 49 例]，分别）和高级别（16.1%[912 例中的 147 例]与 20%[96 例中的 19 例]，分别）（ =.65）。与 DM 相比，DBT 的晚期癌症比例较低（32.6%[968 例中的 316 例]与 43.6%[101 例中的 44 例]，分别； =.04），且 DBT 现患和新发筛查之间也存在差异（39.1%[340 例中的 133 例]与 29.1%[628 例中的 183 例]，分别； <.003）。两组的间期癌发生率（DM 为 0.14/1000，DBT 为 0.2/1000； =.42）无差异。
结论 与 DM 相比，DBT 有助于提高乳腺癌检出率，并显示出较低的晚期癌症率，在新发筛查轮次中观察到进一步的改善。
