Henderson Louise M, Zhu Weiwei, Onega Tracy, Kerlikowske Karla, Miglioretti Diana L, Aiello Bowles Erin J, Sprague Brian L, Weaver Donald L, Tosteson Anna N A, Lee Christoph I
Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Cancer Epidemiology Program Leader, UNC Lineberger Comprehensive Cancer Center.
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
J Am Coll Radiol. 2025 Aug;22(8):897-904. doi: 10.1016/j.jacr.2025.04.008. Epub 2025 Apr 10.
Our objective was to assess the transition from digital mammography (DM) to digital breast tomosynthesis (DBT) screening, the authors compared diagnostic workup type and frequency, workup pathways, and time to resolution of abnormal screening between DBT and DM.
This cohort study included screening examinations with an abnormal results from 2011 to 2020 at 107 facilities across six Breast Cancer Surveillance Consortium registries. Diagnostic workup included diagnostic DM, diagnostic DBT, ultrasound, MRI, and biopsy within 90 days of the abnormal result on screening mammography. Workup modalities and number of workup procedures were compared using differences in proportion and 95% confidence intervals (CIs). Time to diagnostic resolution between DBT and DM was compared using a log-rank test.
Among 77,123 DBT and 197,589 abnormal DM screening examinations with abnormal results, the number of imaging modalities in the diagnostic pathway was similar. The first workup procedure was more often ultrasound after abnormal results on DBT compared with DM (21.1% versus 4.7%). Biopsy rates were higher for DBT versus DM (16.2% versus 14.0%; difference in proportions = 2.27; 95% CI, 1.97-2.58) with biopsies after DM versus DBT more likely surgical versus fine-needle aspiration or core (5.8% versus 3.2%; difference in proportions = 2.6; 95% CI, 2.19-3.01), resulting in a rate of excision biopsy per 1,000 screens with abnormal findings of 5.1 for DBT and 8.0 for DM. Time to diagnostic resolution was similar (median, 10 days).
This study revealed differences in the type of diagnostic workup pathways after abnormal results on screening DBT versus DM. Although the biopsy rate was higher after abnormal results on DBT, the biopsy type may be more invasive (surgical excision) after abnormal results on DM.
我们的目标是评估从数字化乳腺钼靶（DM）筛查向数字化乳腺断层合成（DBT）筛查的转变情况，作者比较了DBT和DM之间的诊断检查类型及频率、检查途径以及异常筛查结果的解决时间。
这项队列研究纳入了2011年至2020年期间六个乳腺癌监测联盟登记处的107个机构中筛查结果异常的检查。诊断检查包括在乳腺钼靶筛查结果异常后的90天内进行的诊断性DM、诊断性DBT、超声、MRI和活检。使用比例差异和95%置信区间（CI）比较检查方式和检查程序的数量。使用对数秩检验比较DBT和DM之间诊断解决的时间。
在77123例DBT和197589例筛查结果异常的DM检查中，诊断途径中的成像方式数量相似。与DM相比，DBT筛查结果异常后首次检查程序更常为超声检查（21.1%对4.7%）。DBT的活检率高于DM（16.2%对14.0%；比例差异=2.27；95%CI，1.97 - 2.58），DM检查后活检更倾向于手术活检，而DBT检查后活检更倾向于细针穿刺或粗针活检（5.8%对3.2%；比例差异=2.6；95%CI，2.19 - 3.01），导致每1000例筛查结果异常中，DBT的切除活检率为5.1，DM为8.0。诊断解决时间相似（中位数为10天）。
本研究揭示了DBT与DM筛查结果异常后诊断检查途径类型的差异。虽然DBT筛查结果异常后的活检率较高，但DM筛查结果异常后的活检类型可能更具侵入性（手术切除）。
