【原】数字化三维乳房钼靶筛查乳腺癌

　　编者按：传统乳房钼靶，类似于传统光学相机，可将乳房的二维透视影像保留于传统胶片；数字化二维乳房钼靶，类似于传统数码相机，可将乳房二维透视影像保留于数码设备；数字化三维乳房钼靶，类似于三维数码相机，可将乳房二维透视影像合成三维透视影像保留于数码设备。数字化三维乳房钼靶可能克服传统乳房钼靶的局限，但是对于筛查乳腺癌，尤其对于人群筛查间期癌的影响，目前尚不明确。

　　2018年2月10日，施普林格·自然旗下《乳腺癌研究与治疗》在线发表挪威癌症登记处、奥斯陆大学、奥斯陆大学医院、奥斯陆城市大学、美国匹兹堡大学的人群前瞻研究报告，调查了数字化三维乳房钼靶对于人群筛查检出癌和间期癌的作用。

　　该人群筛查两人独立读片前瞻研究（OTST）于2010年11月22日～2012年12月19日邀请50～69岁奥斯陆女性接受两年一轮的乳房筛查（二维＋三维），与2006～2009年前两轮筛查（二维）的效果指标、筛查检出癌和间期癌特征进行比较。

　　结果，与前两轮筛查（二维）共5万9877例相比，后一轮筛查（二维＋三维）共2万4301例：

• 敏感性似乎较高：76.2% → 80.8%（378 / 496 → 227 / 281，P = 0.151）

• 特异性显著较高：96.4% → 97.5%（57229 / 59381 → 23427 / 24020，P < 0.001）

• 召回比显著较低：6.7例 → 3.6例（2530 / 378 → 820 / 227，P < 0.001）

• 检出癌显著较多：6.3‰ → 9.3‰（378 / 59877 → 227 / 24301，P < 0.001）

• 间期癌基本不变：2.1‰ → 2.0‰（118 / 59877 → 51 / 24301，P = 0.734）

　　与前两轮筛查（二维）间期癌相比，后一轮筛查（二维＋三维）间期癌的特征相似，但是后一轮筛查（二维＋三维）检出癌的大小、分级、淋巴结状态显著不同，例如：

• 淋巴结阳性率显著较低：39.1% → 39.6%比3.9%

• 分级1级比例显著较高：14.0% → 10.9%比49.0%

• 分级3级比例显著较低：44.9% → 47.8%比9.8%

• ≤ 10mm比例显著较高：17.2% → 9.3%比51.0%

• > 20mm比例显著较低：37.6% → 48.8%比3.9%

　　因此，数字化二维＋三维乳房钼靶筛查的特异性（真阴性）和筛查检出癌比例显著增加。不过，间期癌的比例、大小、分级、淋巴结状态未见显著变化。

Breast Cancer Res Treat. 2018 Feb 10. [Epub ahead of print]

Performance of breast cancer screening using digital breast tomosynthesis: results from the prospective population-based Oslo Tomosynthesis Screening Trial.

Per Skaane, Sofie Sebuodegard, Andriy I. Bandos, David Gur, Bjorn Helge Osteras, Randi Gullien, Solveig Hofvind.

University of Oslo; Cancer Registry of Norway; University of Pittsburgh; Oslo University Hospital; Oslo and Akershus University College of Applied Sciences.

PURPOSE: Digital breast tomosynthesis (DBT) has the potential to overcome limitations of conventional mammography. This study investigated the effects of addition of DBT on interval and detected cancers in population-based screening.

METHODS: Oslo Tomosynthesis Screening Trial (OTST) was a prospective, independent double-reading trial inviting women 50-69 years biennially, comparing full-field digital mammography (FFDM) plus DBT with FFDM alone. Performance indicators and characteristics of screen-detected and interval cancers were compared with two previous FFDM rounds.

RESULTS: 24,301 consenting women underwent FFDM + DBT screening over a 2-year period. Results were compared with 59,877 FFDM examinations during prior rounds. Addition of DBT resulted in a non-significant increase in sensitivity (76.2%, 378/496, vs. 80.8%, 227/281, p = 0.151) and a significant increase in specificity (96.4%, 57229/59381 vs. 97.5%, 23427/24020, p < .001). Number of recalls per screen-detected cancer decreased from 6.7 (2530/378) to 3.6 (820/227) with DBT (p < .001). Cancer detection per 1000 women screened increased (6.3, 378/59877, vs. 9.3, 227/24301, p < .001). Interval cancer rate per 1000 screens for FFDM + DBT remained similar to previous FFDM rounds (2.1, 51/24301 vs. 2.0, 118/59877, p = 0.734). Interval cancers post-DBT were comparable to prior rounds but significantly different in size, grade, and node status from cancers detected only using DBT. 39.6% (19/48) of interval cancers had positive nodes compared with only 3.9% (2/51) of additional DBT-only-detected cancers.

CONCLUSIONS: DBT-supplemented screening resulted in significant increases in screen-detected cancers and specificity. However, no significant change was observed in the rate, size, node status, or grade of interval cancers.

ClinicalTrials.gov: NCT01248546.

KEYWORDS: Breast neoplasms, Breast cancer screening, Digital breast tomosynthesis, Interval breast cancer, Mammography

DOI: 10.1007/s10549-018-4705-2