Effectiveness of Digital Breast Tomosynthesis Compared With Digital Mammography Outcomes Analysis From 3 Years of Breast Cancer Screening
Effectiveness of Digital Breast Tomosynthesis Compared With Digital Mammography Outcomes Analysis From 3 Years of Breast Cancer Screening
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DOI：
10.1001/jamaoncol.2015.5536
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发表时间：
2016-06-01
期刊：
影响因子：
28.4
通讯作者：
Conant, Emily F.
中科院分区：
文献类型：
--
作者：
McDonald, Elizabeth S.;Oustimov, Andrew;Conant, Emily F.
重要性与单独使用数字乳腺X射线摄影（DM）进行筛查相比，数字乳腺断层合成摄影（DBT）联合数字乳腺X射线摄影（DM）进行乳腺癌筛查可减少假阳性检查，提高癌症检出率。然而，DBT筛查的纵向表现是未知的。为了确定在人群水平上，在最初实施DBT筛查后观察到的改善的结果是否随着时间的推移是可持续的，并在个体水平上评估超过1次DBT筛查的效果。和参与者回顾性分析了在城市，连续4年在学术乳腺中心（DM，0年; DBT，1-3年）。该研究于2010年9月1日至2014年9月30日（不包括2011年9月，这是从DM到DBT的过渡期）进行，共44468起筛选事件，可归因于23958名独特女性。评估了每个DBT年和DM年之间以及仅进行1次、2次或3次DBT筛查的妇女组之间的筛查结果差异，并估计了根据年龄、种族/民族、乳腺密度和既往乳房X线检查调整后的回忆几率。数据分析在2015年2月16日至10月26日期间进行。EXPOSURE补充DBT的数字乳腺X线摄影筛查。主要结果和指标确定召回率、每名召回患者的癌症病例数以及活检和间隔癌症率。（平均[SD]年龄，56.8 [11.0]岁）：第0年队列（DM 0），10 728名女性;第1年队列（DBT 1），11 007名;第2年队列（DBT 2），11 157名;第3年队列（DBT 3），11 576名。DBT第1年至第3年的召回率略有上升（分别为88，90和92/1000筛选），但与DM 0率（104/1000筛选）相比仍显着降低。以比值比（95%CI）报告，结果为DM vs DBT 1，0.83（0.76-0.91，P < .001）; DM vs DBT 2，0.85（0.78-0.93，P < .001）; DM vs DBT 3，0.87（0.80-0.95，P = .003）。DBT第1年至第3年，每名召回患者的癌症病例继续从DM 0率4.4%上升至6.2%（P = .06）、6.5%（P = .03）和6.7%（P = .02）。对研究期间仅接受1次、2次或3次DBT筛查的个体女性进行的最近一次筛查的结果评估显示，每1000名筛查者的回忆率分别下降了130、78和59（P < .001）。使用可用的随访数据确定的间隔期癌症发生率从使用DM筛查的0.7/1000名女性下降到使用DBT 1筛查的0.5/1000名女性。结论和相关性数字乳腺断层合成摄影筛查结果是可持续的，召回率显著降低，每名召回患者的癌症病例增加，间隔期癌症减少。
IMPORTANCE Breast cancer screening with digital breast tomosynthesis (DBT) combined with digital mammography (DM) decreases false-positive examinations and increases cancer detection compared with screening with DM alone. However, the longitudinal performance of DBT screening is unknown.OBJECTIVES To determine whether the improved outcomes observed after initial implementation of DBT screening are sustainable over time at a population level and to evaluate the effect of more than 1 DBT screening at the individual level.DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of screening mammography metrics was performed for all patients presenting for screening mammography in an urban, academic breast center during 4 consecutive years (DM, year 0; DBT, years, 1-3). The study was conducted from September 1, 2010, to September 30, 2014 (excluding September 2011, which was the transition period from DM to DBT), for a total of 44 468 screening events attributable to a total of 23 958 unique women. Differences in screening outcomes between each DBT year and the DM year, as well as between groups of women with only 1, 2, or 3 DBT screenings, were assessed, and the odds of recall adjusted for age, race/ethnicity, breast density, and prior mammograms were estimated. Data analysis was performed between February 16 and October 26, 2015.EXPOSURE Digital mammography screening supplemented with DBT.MAIN OUTCOMES AND MEASURES Recall rates, cancer cases per recalled patients, and biopsy and interval cancer rates were determined.RESULTS Screening outcome metrics were evaluated for a total of 44 468 examinations attributable to 23 958 unique women (mean [SD] age, 56.8 [11.0] years) over a 4-year period: year 0 cohort (DM0), 10 728 women; year 1 cohort (DBT1), 11 007; year 2 cohort (DBT2), 11 157; and year 3 cohort (DBT3), 11 576. Recall rates rose slightly for years 1 to 3 of DBT (88, 90, and 92 per 1000 screened, respectively) but remained significantly reduced compared with the DM0 rate of 104 per 1000 screened. Reported as odds ratios (95% CIs), the findings were DM vs DBT1, 0.83 (0.76-0.91, P < .001); DM vs DBT2, 0.85 (0.78-0.93, P < .001); and DM vs DBT3, 0.87 (0.80-0.95, P = .003). The cancer cases per recalled patients continued to rise from DM0 rate of 4.4% to 6.2%(P = .06), 6.5%(P = .03), and 6.7%(P = .02) for years 1 to 3 of DBT, respectively. Outcomes assessed for the most recent screening for individual women undergoing only 1, 2, or 3 DBT screenings during the study period demonstrated decreasing recall rates of 130, 78, and 59 per 1000 screened, respectively (P < .001). Interval cancer rates, determined using available follow-up data, decreased from 0.7 per 1000 women screened with the use of DM to 0.5 per 1000 screened with the use of DBT1.CONCLUSIONS AND RELEVANCE Digital breast tomosynthesis screening outcomes are sustainable, with significant recall reduction, increasing cancer cases per recalled patients, and a decline in interval cancers.