Association of Digital Breast Tomosynthesis vs Digital Mammography With Cancer Detection and Recall Rates by Age and Breast Density
Association of Digital Breast Tomosynthesis vs Digital Mammography With Cancer Detection and Recall Rates by Age and Breast Density
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DOI：
10.1001/jamaoncol.2018.7078
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发表时间：
2019-05-01
期刊：
影响因子：
28.4
通讯作者：
DeAguiar, Cheryl
中科院分区：
文献类型：
--
作者：
Conant, Emily F.;Barlow, William E.;DeAguiar, Cheryl
重要性。与数字乳腺 X 线摄影 (DM) 相比，使用数字乳腺断层合成 (DBT) 进行乳腺癌筛查检查已被证明可减少假阳性检测结果并增加乳腺癌检出率。关于检测到的乳腺癌类型的大小和分期以及它们与年龄和乳腺密度的关系知之甚少。目的确定使用 DBT 的筛查检查是否可以检测到与改善预后相关的乳腺癌，并比较不同患者年龄和乳腺密度的检出率。设计、设置。这项对基于人群的研究通过个性化方案优化筛查 (PROSPR) 联盟的 3 个研究中心的前瞻性队列数据的回顾性分析包括 2011 年 1 月 1 日至 2014 年 9 月 30 日期间使用 DM 和 DBT 接受筛查检查的 40 至 74 岁女性的数据。统计分析是在 2017 年 11 月 8 日至 8 月 14 日进行的。 2018.暴露在乳腺癌筛查检查中使用 DBT 作为 DM 的补充。主要结果和测量召回率、癌症检出率、阳性预测值、活检率和浸润性癌症亚型的分布。结果在 96 269 名女性中（所有检查的平均 [SD] 患者年龄为 55.9 [9.0] 岁），DM 患者年龄为 56.4 (9.0) 岁， DBT 为 54.6 (8.9) 年。在 180 340 次乳腺癌筛查检查中，129 369 次检查（71.7%）使用 DM，50 971 次检查（28.3%）使用 DBT。与 DM（422 名女性中的 276 名女性 [65.4%]）相比，DBT 筛查检查（99 名女性中的 73 名女性 [73.7%]）与更小、更常见的淋巴结阴性、HER2 阴性侵袭性癌症的检测相关。 DBT 筛查检查也与较低的召回率相关（比值比，0.64；95% Cl，0.57-0.72；P
IMPORTANCE. Breast cancer screening examinations using digital breast tomosynthesis (DBT) has been shown to be associated with decreased false-positive test results and increased breast cancer detection compared with digital mammography (DM). Little is known regarding the size and stage of breast cancer types detected and their association with age and breast density.OBJECTIVE To determine whether screening examinations using DBT detect breast cancers that are associated with an improved prognosis and to compare the detection rates by patient age and breast density.DESIGN, SETTING. AND PARTICIPANTS This retrospective analysis of prospective cohort data from 3 research centers in the Population-based Research Optimizing Screening Through Personalized Regimens (PROSPR) consortium included data of women aged 40 to 74 years who underwent screening examinations using DM and DBT from January 1, 2011, through September 30, 2014. Statistical analysis was performed from November 8, 2017, to August 14, 2018.EXPOSURES Use of DBT as a supplement to DM at breast cancer screening examination.MAIN OUTCOMES AND MEASURES Recall rate, cancer detection rate, positive predictive value, biopsy rate, and distribution of invasive cancer subtypes.RESULTS Among 96 269 women (mean [SD] patient age for all examinations, 55.9 [9.0] years), patient age was 56.4 (9.0) years for DM and 54.6 (8.9) years for DBT. Of 180 340 breast cancer screening examinations, 129 369 examinations (71.7%) used DM and 50 971 examinations (28.3%) used DBT. Screening examination with DBT (73 of 99 women [73.7%]) was associated with the detection of smaller, more often node-negative, HER2-negative, invasive cancers compared with DM (276 of 422 women [65.4%]). Screening examination with DBT was also associated with lower recall (odds ratio, 0.64; 95% Cl, 0.57-0.72; P