美国加州大学Karla Kerlikowske团队比较了数字乳腺断层合成筛查与数字乳腺X线片筛查与间隔浸润性和晚期乳腺癌风险的关系。相关论文于2022年6月14日发表在《美国医学会杂志》上。

数字乳腺断层合成（DBT）的开发是为了提高致密乳腺女性的癌症检测率。根据乳腺密度和乳腺癌风险来评估侵袭性乳腺癌和晚期乳腺癌的间隔发病率、与乳腺癌死亡相关的中期预后，仍需进一步研究。

为了通过乳腺密度和乳腺癌风险的程度，来评估DBT筛查与数字乳腺X线片相比，是否与较低的间隔浸润性癌和晚期乳腺癌的风险相关，2011-2018年，研究组在44家美国乳腺癌监测联盟（BCSC）机构对504427名年龄在40至79岁之间的女性进行了1003900次数字乳腺X线片筛查和375189次DBT筛查的队列研究，通过与州或地区癌症登记处的联系，跟踪2019年之前的癌症诊断。

暴露因素为乳腺成像报告和数据系统（BI-RADS）乳腺密度与BCSC 5年乳腺癌风险。主要结局为乳腺钼靶筛查后12个月内间隔浸润性癌和乳腺钼靶筛查后12个月内晚期乳腺癌（预后病理II期或更高）的每1000次检查的比率，均采用逆概率加权估计。

在504427名研究人群中，乳腺X光检查时的中位年龄为58岁。DBT与数字乳腺X线片的间隔浸润癌发生率分别为每1000次检查0.57例和0.61例，没有显著差异；在所有836250项BCSC 5年风险低于1.67%（低至平均风险）的检查中，或所有413061项BCSC 5年风险为1.67%或更高（高风险）的检查中亦无显著差异。

在中低风险或高风险的乳房几乎全是脂肪、分散的纤维腺密度或乳腺密度不均的女性中，DBT与数字乳腺X线片的晚期癌症发生率没有显著差异。在3.6%的乳腺密度极高且乳腺癌高危的女性中，DBT与数字乳腺X线片相比，晚期癌症发生率分别为每1000次检查0.27例与0.80例，发生率显著降低；但在中低风险的女性中，DBT与数字乳腺X线片筛查的晚期癌症发生率分别为每1000次检查0.54例与0.42例，组间差异不显著。

研究结果表明，对于3.6%的乳腺密度极高且乳腺癌风险较高的女性，DBT筛查与数字乳腺X线片筛查相比，间隔浸润性癌风险无显著差异，但晚期乳腺癌风险显著降低。

附：英文原文

Title: Association of Screening With Digital Breast Tomosynthesis vs Digital Mammography With Risk of Interval Invasive and Advanced Breast Cancer

Author: Karla Kerlikowske, Yu-Ru Su, Brian L. Sprague, Anna N. A. Tosteson, Diana S. M. Buist, Tracy Onega, Louise M. Henderson, Nila Alsheik, Michael C. S. Bissell, Ellen S. O’Meara, Christoph I. Lee, Diana L. Miglioretti

Issue&Volume: 2022/06/14

Abstract:

Importance  Digital breast tomosynthesis (DBT) was developed with the expectation of improving cancer detection in women with dense breasts. Studies are needed to evaluate interval invasive and advanced breast cancer rates, intermediary outcomes related to breast cancer mortality, by breast density and breast cancer risk.

Objective  To evaluate whether DBT screening is associated with a lower likelihood of interval invasive cancer and advanced breast cancer compared with digital mammography by extent of breast density and breast cancer risk.

Design, Setting, and Participants  Cohort study of 504427 women aged 40 to 79 years who underwent 1003900 screening digital mammography and 375189 screening DBT examinations from 2011 through 2018 at 44 US Breast Cancer Surveillance Consortium (BCSC) facilities with follow-up for cancer diagnoses through 2019 by linkage to state or regional cancer registries.

Exposures  Breast Imaging Reporting and Data System (BI-RADS) breast density; BCSC 5-year breast cancer risk.

Main Outcomes and Measures  Rates per 1000 examinations of interval invasive cancer within 12 months of screening mammography and advanced breast cancer (prognostic pathologic stage II or higher) within 12 months of screening mammography, both estimated with inverse probability weighting.

Results  Among 504427 women in the study population, the median age at time of mammography was 58 years (IQR, 50-65 years). Interval invasive cancer rates per 1000 examinations were not significantly different for DBT vs digital mammography (overall, 0.57 vs 0.61, respectively; difference, 0.04; 95% CI, 0.14 to 0.06; P=.43) or among all the 836250 examinations with BCSC 5-year risk less than 1.67% (low to average-risk) or all the 413061 examinations with BCSC 5-year risk of 1.67% or higher (high risk) across breast density categories. Advanced cancer rates were not significantly different for DBT vs digital mammography among women at low to average risk or at high risk with almost entirely fatty, scattered fibroglandular densities, or heterogeneously dense breasts. Advanced cancer rates per 1000 examinations were significantly lower for DBT vs digital mammography for the 3.6% of women with extremely dense breasts and at high risk of breast cancer (13291 examinations in the DBT group and 31300 in the digital mammography group; 0.27 vs 0.80 per 1000 examinations; difference, 0.53; 95% CI, 0.97 to 0.10) but not for women at low to average risk (10611 examinations in the DBT group and 37796 in the digital mammography group; 0.54 vs 0.42 per 1000 examinations; difference, 0.12; 95% CI, 0.09 to 0.32).

Conclusions and Relevance  Screening with DBT vs digital mammography was not associated with a significant difference in risk of interval invasive cancer and was associated with a significantly lower risk of advanced breast cancer among the 3.6% of women with extremely dense breasts and at high risk of breast cancer. No significant difference was observed in the 96.4% of women with nondense breasts, heterogeneously dense breasts, or with extremely dense breasts not at high risk.

DOI: 10.1001/jama.2022.7672

Source: https://jamanetwork.com/journals/jama/article-abstract/2793253