Diagnostic performance of digital versus film mammography for breast-cancer screening
Diagnostic performance of digital versus film mammography for breast-cancer screening
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DOI：
10.1056/nejmoa052911
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发表时间：
2005-10-27
影响因子：
158.5
通讯作者：
Rebner, M
中科院分区：
文献类型：
--
作者：
Pisano, ED;Gatsonis, C;Rebner, M
背景：乳房x线摄影对乳腺密度较高的女性乳腺癌的检测灵敏度有限。我们评估了数字乳房x光检查是否可以避免这些局限性。方法：在美国和加拿大的33个地点，共有49,528名无症状妇女接受了数字和胶片乳房x光检查。这些妇女中有42,760人（86.3%）获得了所有相关信息。乳房x光片由两名放射科医生独立解读。乳腺癌状况的确定是基于研究开始后15个月内进行的乳房活检或研究开始后至少10个月进行的随访乳房x光检查。采用受试者工作特征（ROC）分析对结果进行评价。结果：在整个人群中，数字乳房x线摄影和胶片x线摄影的诊断准确率相似（两种方法在ROC曲线下面积的差异为0.03；95%置信区间为-0.02 ~ 0.08；P=0.18）。然而，在50岁以下的女性（曲线下面积差值为0.15,95%可信区间为0.05 ~ 0.25，P=0.002）、乳房非均匀致密或极度致密的女性（差值为0.11,95%可信区间为0.04 ~ 0.18，P=0.003）、绝经前或围绝经期女性（差值为0.15,95%可信区间为0.05 ~ 0.24,95%可信区间为0.05 ~ 0.24）中，数字乳房x线摄影的准确性显著高于胶片x线摄影。P = 0.002)。结论：数字乳房x线摄影和胶片乳房x线摄影作为乳腺癌筛查手段的总体诊断准确性相似，但数字乳房x线摄影对50岁以下女性、放射学上乳房致密的女性、绝经前或围绝经期女性的诊断准确性更高。(ClinicalTrials.govnumber NCT00008346)。
BACKGROUND:Film mammography has limited sensitivity for the detection of breast cancer in women with radiographically dense breasts. We assessed whether the use of digital mammography would avoid some of these limitations.METHODS:A total of 49,528 asymptomatic women presenting for screening mammography at 33 sites in the United States and Canada underwent both digital and film mammography. All relevant information was available for 42,760 of these women (86.3 percent). Mammograms were interpreted independently by two radiologists. Breast-cancer status was ascertained on the basis of a breast biopsy done within 15 months after study entry or a follow-up mammogram obtained at least 10 months after study entry. Receiver-operating-characteristic (ROC) analysis was used to evaluate the results.RESULTS:In the entire population, the diagnostic accuracy of digital and film mammography was similar (difference between methods in the area under the ROC curve, 0.03; 95 percent confidence interval, -0.02 to 0.08; P=0.18). However, the accuracy of digital mammography was significantly higher than that of film mammography among women under the age of 50 years (difference in the area under the curve, 0.15; 95 percent confidence interval, 0.05 to 0.25; P=0.002), women with heterogeneously dense or extremely dense breasts on mammography (difference, 0.11; 95 percent confidence interval, 0.04 to 0.18; P=0.003), and premenopausal or perimenopausal women (difference, 0.15; 95 percent confidence interval, 0.05 to 0.24; P=0.002).CONCLUSIONS:The overall diagnostic accuracy of digital and film mammography as a means of screening for breast cancer is similar, but digital mammography is more accurate in women under the age of 50 years, women with radiographically dense breasts, and premenopausal or perimenopausal women. (ClinicalTrials.govnumber, NCT00008346.).