Cardona Ortegón Jose D, Valencia Sergio, Campaña Perilla Laura, Guerra Barón Julián D, Romero Javier A
Radiology, University Hospital Fundación Santa Fe de Bogotá, Bogotá, COL.
Radiology, El Bosque University, Bogotá, COL.
Cureus. 2024 Nov 19;16(11):e74026. doi: 10.7759/cureus.74026. eCollection 2024 Nov.
Breast density is a strong predictor of breast cancer. However, the difference in risk between breast density categories C and D remains inadequately explored. Given the low occurrence of extremely dense breasts, this investigation is crucial because it may lead to modifications in screening techniques for those with these conditions.
The objective of the study is to evaluate the difference in breast cancer risk among women undergoing mammography and biopsy at a tertiary referral hospital in Colombia, based on American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) results in categories of breast density C (heterogeneously dense) and D (extremely dense). Methods: This retrospective cross-sectional study recorded variables from the mammographic BI-RADS scale, as well as histological and clinical variables from digital medical records. A stratified analysis of lesion malignancy/benignity was conducted according to density category by mammography and histological findings. The association between mammographic breast density subclassification of dense breasts and the occurrence or not of pathology-defined malignancy was sought. Results: A total of 107 patients with breast density in categories C and D were included, with 88.7% having heterogeneously dense breasts. The frequency of breast cancer was 32%. Infiltrating ductal carcinoma was the most frequently diagnosed malignancy (N = 14). A higher BI-RADS category was correlated with breast density grade D and malignancy. A statistically significant association (p <0.045, RR 1.95, CI: 1.12-3.50) was found when comparing breast density (categories C and D) with the risk of malignancy. The positive predictive value (PPV) varied across different BI-RADS categories (BI-RADS 4A 25% vs. 0%; p-value 0.005; BI-RADS 4B 50% vs 10.5%; p-value 0.032).
Efforts and resources should be focused on patients with extremely dense breasts, emphasizing the importance of additional (individualized) screening. Breast density could change the PPV within each BI-RADS category. However, further studies are needed to define the risk associated with each breast density subcategory and within BI-RADS categories, as well as to assess the efficacy of additional screening in patients with extremely dense breasts.
乳腺密度是乳腺癌的一个强有力的预测指标。然而，乳腺密度C类和D类之间的风险差异仍未得到充分研究。鉴于极度致密乳腺的发生率较低，这项调查至关重要，因为它可能会导致针对这些情况的筛查技术发生改变。
本研究的目的是根据美国放射学会乳腺影像报告和数据系统（BI-RADS）中乳腺密度C类（不均匀致密）和D类（极度致密）的结果，评估在哥伦比亚一家三级转诊医院接受乳房X线摄影和活检的女性中乳腺癌风险的差异。
这项回顾性横断面研究记录了乳房X线摄影BI-RADS量表中的变量，以及数字医疗记录中的组织学和临床变量。根据乳房X线摄影密度类别和组织学结果对病变的恶性/良性进行分层分析。探讨了致密乳腺的乳房X线摄影乳腺密度亚分类与病理定义的恶性肿瘤发生与否之间的关联。
总共纳入了107例乳腺密度为C类和D类的患者，其中88.7%为不均匀致密乳腺。乳腺癌的发生率为32%。浸润性导管癌是最常诊断出的恶性肿瘤（N = 14）。较高的BI-RADS类别与乳腺密度D级和恶性肿瘤相关。在比较乳腺密度（C类和D类）与恶性肿瘤风险时，发现了具有统计学意义的关联（p <0.045，RR 1.95，CI：1.12 - 3.50）。阳性预测值（PPV）在不同的BI-RADS类别中有所不同（BI-RADS 4A为25%对0%；p值0.005；BI-RADS 4B为50%对10.5%；p值0.032）。
应将努力和资源集中在极度致密乳腺的患者身上，强调额外（个体化）筛查的重要性。乳腺密度可能会改变每个BI-RADS类别中的PPV。然而，需要进一步研究来确定与每个乳腺密度亚类别以及BI-RADS类别内相关的风险，以及评估对极度致密乳腺患者进行额外筛查的效果。
