Case-control study of mammographic density and breast cancer risk using processed digital mammograms.
Case-control study of mammographic density and breast cancer risk using processed digital mammograms.
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DOI：
10.1186/s13058-016-0715-3
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发表时间：
2016-05-21
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影响因子：
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通讯作者：
Sieh W
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作者：
Habel LA;Lipson JA;Achacoso N;Rothstein JH;Yaffe MJ;Liang RY;Acton L;McGuire V;Whittemore AS;Rubin DL;Sieh W
在美国，全视野数字乳房X光检查（FFDM）已很大程度上取代了胶片屏幕乳房X光检查。通过乳房 X 光片评估的乳腺密度与乳腺癌风险密切相关，但用于临床护理的经过处理的 FFDM 图像的数据有限。我们对北加州 Kaiser Permanente 基因、环境和健康研究项目的非西班牙裔白人女性参与者进行了一项病例对照研究，这些女性参与者年龄在 40 至 74 岁之间，并在 Hologic FFDM 机器上进行了乳房 X 光检查。病例 (n=297) 是在 FFDM 筛查后首次诊断出患有浸润性乳腺癌的女性。对于每个病例，选择最多 5 名对照（n = 1149），根据 FFDM 的年龄和年份以及图像批次编号进行匹配，并且在匹配病例的诊断年龄时仍在随访且无乳腺癌病史。放射技术专家使用 Cumulus 评估百分比密度 (PD) 和致密面积 (DA)。在调整体重指数、产次、乳腺癌一级家族史、乳房面积和绝经期激素使用后，使用条件逻辑回归来估计与 PD 和 DA 相关的乳腺癌的比值比 (OR)，以标准差 (SD) 增量连续建模，并以五分位数分类。 23 个图像批次的重复 PD 测量的 Pearson r 值为 0.956（范围 0.902 至 0.983），读取器内的中值再现性很高。 PD 的总体平均值为 20.02（SD，14.61），DA 的总体平均值为 27.63 cm2（18.22 cm2）。与每个 SD 增量相关的乳腺癌调整后的 OR 值，PD 为 1.70（95% 置信区间，1.41–2.04），DA 为 1.54（1.34–1.77）。每个五分位数的调整后 OR 为：PD 的 1.00（参考值）、1.49（0.91–2.45）、2.57（1.54–4.30）、3.22（1.91–5.43）、4.88（2.78–8.55），以及 1.00（参考值）、1.43 DA 为 (0.85–2.40)、2.53 (1.53–4.19)、2.85 (1.73–4.69)、3.48 (2.14–5.65)。在处理过的 FFDM 图像上使用 Cumulus 测量的 PD 和 DA 与乳腺癌风险呈正相关，其关联程度与之前报道的胶片乳房 X 光检查相似。在一般实践环境中为常规临床护理而获取的经过处理的数字乳房X光照片适用于乳腺密度和癌症研究。
Full-field digital mammography (FFDM) has largely replaced film-screen mammography in the US. Breast density assessed from film mammograms is strongly associated with breast cancer risk, but data are limited for processed FFDM images used for clinical care. We conducted a case-control study nested among non-Hispanic white female participants of the Research Program in Genes, Environment and Health of Kaiser Permanente Northern California who were aged 40 to 74 years and had screening mammograms acquired on Hologic FFDM machines. Cases (n = 297) were women with a first invasive breast cancer diagnosed after a screening FFDM. For each case, up to five controls (n = 1149) were selected, matched on age and year of FFDM and image batch number, and who were still under follow-up and without a history of breast cancer at the age of diagnosis of the matched case. Percent density (PD) and dense area (DA) were assessed by a radiological technologist using Cumulus. Conditional logistic regression was used to estimate odds ratios (ORs) for breast cancer associated with PD and DA, modeled continuously in standard deviation (SD) increments and categorically in quintiles, after adjusting for body mass index, parity, first-degree family history of breast cancer, breast area, and menopausal hormone use. Median intra-reader reproducibility was high with a Pearson’s r of 0.956 (range 0.902 to 0.983) for replicate PD measurements across 23 image batches. The overall mean was 20.02 (SD, 14.61) for PD and 27.63 cm2 (18.22 cm2) for DA. The adjusted ORs for breast cancer associated with each SD increment were 1.70 (95 % confidence interval, 1.41–2.04) for PD, and 1.54 (1.34–1.77) for DA. The adjusted ORs for each quintile were: 1.00 (ref.), 1.49 (0.91–2.45), 2.57 (1.54–4.30), 3.22 (1.91–5.43), 4.88 (2.78–8.55) for PD, and 1.00 (ref.), 1.43 (0.85–2.40), 2.53 (1.53–4.19), 2.85 (1.73–4.69), 3.48 (2.14–5.65) for DA. PD and DA measured using Cumulus on processed FFDM images are positively associated with breast cancer risk, with similar magnitudes of association as previously reported for film-screen mammograms. Processed digital mammograms acquired for routine clinical care in a general practice setting are suitable for breast density and cancer research.