Nakamura Akira, Ohnuki Koji, Takahashi Haruka, Usami Shin, Ishida Yuki, Shibata Setsuko, Umemura Akiko, Kano Atsushi
Department of Breast and Endocrine Surgery, Iwate Prefectural Central Hospital, 4-1, Ueda, Morioka, Iwate, 020-0066, Japan.
Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Breast Cancer. 2025 Mar;32(2):385-392. doi: 10.1007/s12282-024-01664-5. Epub 2025 Jan 2.
The accuracy of mammography in breast cancer screening is influenced by different factors such as breast composition. However, previous studies did not evaluate the impact of breast size on examination accuracy. This study aimed to investigate the influence of breast size on the accuracy of mammography and ultrasonography in breast cancer screening using compressed breast thickness (CBT) on mammography as an indicator of breast size.
This study included Japanese women in their 40 s who underwent mammography alone (MG group) or mammography with adjunctive ultrasonography (MG + US group) at the Iwate Cancer Society (Iwate, Japan) in 2018 and 2019. Based on CBT, the participants were further divided into the L group (< 30 mm) and U group (≥ 30 mm). The recall rate, cancer detection rate, and positive predictive value of the L and U groups based on screening method and breast size were evaluated.
Of 15,897 patients, 10,162 and 5735 underwent mammography alone and mammography with adjunctive ultrasonography, respectively. In the L group, the MG and MG + US groups did not significantly differ in terms of recall rate (1.9%, 95% CI 1.4-2.6 vs 1.9%, 1.2-2.9; p = 0.972). Moreover, the MG + US group had a higher cancer detection rate than the MG group. However, the difference was not significant (0.20%, 0.05-0.51 vs 0.63%, 0.25-1.29; p = 0.054). In the U group, the MG + US group had a significantly higher recall rate than the MG group (2.2%, 1.9-2.5 vs 2.9%, 2.5-3.4; p < 0.05). Nevertheless, there was no significant difference in the cancer detection rate (0.15%, 0.08-0.25 vs 0.28%, 0.15-0.48; p = 0.099).
To the best of our knowledge, this study first showed that breast size, in addition to breast composition, influences the accuracy of mammography and ultrasonography in breast cancer screening. Hence, screening methods tailored to individual breast characteristics should be considered.
乳腺钼靶检查在乳腺癌筛查中的准确性受多种因素影响，如乳房组织构成。然而，既往研究未评估乳房大小对检查准确性的影响。本研究旨在以乳腺钼靶检查时的压迫后乳腺厚度（CBT）作为乳房大小的指标，探讨乳房大小对乳腺癌筛查中乳腺钼靶检查和超声检查准确性的影响。
本研究纳入了2018年和2019年在岩手癌症协会（日本岩手）接受单纯乳腺钼靶检查（MG组）或乳腺钼靶联合超声检查（MG + US组）的40多岁日本女性。根据CBT，将参与者进一步分为L组（<30mm）和U组（≥30mm）。评估基于筛查方法和乳房大小的L组和U组的召回率、癌症检出率和阳性预测值。
在15897例患者中，分别有10162例和5735例接受了单纯乳腺钼靶检查和乳腺钼靶联合超声检查。在L组中，MG组和MG + US组的召回率无显著差异（1.9%，95%CI 1.4 - 2.6 vs 1.9%，1.2 - 2.9；p = 0.972）。此外，MG + US组的癌症检出率高于MG组。然而，差异不显著（0.20%，0.05 - 0.51 vs 0.63%，0.25 - 1.29；p = 0.054）。在U组中，MG + US组的召回率显著高于MG组（2.2%，1.9 - 2.5 vs 2.9%，2.5 - 3.4；p < 0.05）。然而，癌症检出率无显著差异（0.15%，0.08 - 0.25 vs 0.28%，0.15 - 0.48；p = 0.099）。
据我们所知，本研究首次表明，除乳房组织构成外，乳房大小也会影响乳腺癌筛查中乳腺钼靶检查和超声检查的准确性。因此，应考虑针对个体乳房特征量身定制筛查方法。
