Digital Breast Tomosynthesis with Synthesized Two-Dimensional Images versus Full-Field Digital Mammography for Population Screening: Outcomes from the Verona Screening Program
Digital Breast Tomosynthesis with Synthesized Two-Dimensional Images versus Full-Field Digital Mammography for Population Screening: Outcomes from the Verona Screening Program
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DOI：
10.1148/radiol.2017170745
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发表时间：
2018-04-01
期刊：
影响因子：
19.7
通讯作者：
Houssami, Nehmat
中科院分区：
文献类型：
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作者：
Caumo, Francesca;Zorzi, Manuel;Houssami, Nehmat
目的：研究基于数字乳腺断层合成摄影（DBT）加合成二维（2D）乳腺X射线摄影的乳腺癌筛查计划与全视野数字乳腺X射线摄影（FFDM）后乳腺癌筛查计划的结局。材料和方法：这项前瞻性研究包括16666名年龄在50岁以下的无症状女性，69岁，于2015年4月至2016年3月招募，在维罗纳筛查项目中进行DBT加合成2D筛查。纳入了前一年接受FFDM筛查的女性（n = 14 423）的比较队列。通过计算与每个结果相关的比例，比较两组的筛查检测措施，并用多变量logistic回归估计相对率（RR）。结果：DBT+合成2D成像的癌症检出率（CDR）为9.30/1000次筛查检查，而FFDM为5.41/1000次筛查检查（RR，1.72; 95%置信区间[CI]：1.30，2.29）。在低乳腺密度（RR，1.53; 95% CI：1.13，2.10）或高乳腺密度（RR，2.86; 95% CI：1.42，6.25）女性中，接受DBT+合成2D成像筛查的患者的CDR显著高于接受FFDM筛查的患者。DBT加合成2D成像的回忆阳性预测值（PPV）几乎翻了一番：23.3%与12.9%接受FFDM筛查的回忆患者（RR，1.81; 95% CI：1.34，2.47）。两组的召回率相似（RR，0.95; 95% CI：0.84，1.06），而DBT+合成2D成像的有创评估召回率高于FFDM（RR，1.93; 95% CI：1.31，2.03）。与FFDM（每小时60次筛查）相比，使用DBT+合成2D成像（每小时38.5次筛查）进行的筛查检查每小时解读的筛查研究平均数量显著更低（P
Purpose: To examine the outcomes of a breast cancer screening program based on digital breast tomosynthesis (DBT) plus synthesized two-dimensional (2D) mammography compared with those after full-field digital mammography (FFDM).Materials and Methods: This prospective study included 16 666 asymptomatic women aged 50-69 years who were recruited in April 2015 through March 2016 for DBT plus synthetic 2D screening in the Verona screening program. A comparison cohort of women screened with FFDM (n = 14 423) in the previous year was included. Screening detection measures for the two groups were compared by calculating the proportions associated with each outcome, and the relative rates (RRs) were estimated with multivariate logistic regression.Results: Cancer detection rate (CDR) for DBT plus synthetic 2D imaging was 9.30 per 1000 screening examinations versus 5.41 per 1000 screening examinations with FFDM (RR, 1.72; 95% confidence interval [CI]: 1.30, 2.29). CDR was significantly higher in patients screened with DBT plus synthetic 2D imaging than in those screened with FFDM among women classified as having low breast density (RR, 1.53; 95% CI: 1.13, 2.10) or high breast density (RR, 2.86; 95% CI: 1.42, 6.25). The positive predictive value (PPV) for recall was almost doubled with DBT plus synthetic 2D imaging: 23.3% versus 12.9% of recalled patients who were screened with FFDM (RR, 1.81; 95% CI: 1.34, 2.47). The recall rate was similar between groups (RR, 0.95; 95% CI: 0.84, 1.06), whereas the recall rate with invasive assessment was higher for DBT plus synthetic 2D imaging than for FFDM (RR, 1.93; 95% CI: 1.31, 2.03). The mean number of screening studies interpreted per hour was significantly lower for screening examinations performed with DBT plus synthetic 2D imaging (38.5 screens per hour) than with FFDM (60 screens per hour) (P