Rapid review: Estimates of incremental breast cancer detection from tomosynthesis (3D-mammography) screening in women with dense breasts

High breast tissue density increases breast cancer (BC) risk, and the risk of an interval BC in mammography screening. Density-tailored screening has mostly used adjunct imaging to screen women with dense breasts, however, the emergence of tomosynthesis (3D-mammography) provides an opportunity to steer density-tailored screening in new directions potentially obviating the need for adjunct imaging. A rapid review (a streamlined evidence synthesis) was performed to summarise data on tomosynthesis screening in women with heterogeneously dense or extremely dense breasts, with the aim of estimating incremental (additional) BC detection attributed to tomosynthesis in comparison with standard 2D-mammography. Meta-analysed data from prospective trials comparing these mammography modalities in the same women (N = 10,188) in predominantly biennial screening showed significant incremental BC detection of 3.9/1000 screens attributable to tomosynthesis (P < 0.001). Studies comparing different groups of women screened with tomosynthesis (N = 103,230) or with 2D-mammography (N = 177,814) yielded a pooled difference in BC detection of 1.4/1000 screens representing significantly higher BC detection in tomosynthesis-screened women (P < 0.001), and a pooled difference for recall of −23.3/1000 screens representing significantly lower recall in tomosynthesis-screened groups (P < 0.001), than for 2D-mammography. These estimates can inform planning of future trials of density-tailored screening and may guide discussion of screening women with dense breasts.     

Incremental effect from integrating 3D-mammography (tomosynthesis) with 2D-mammography: Increased breast cancer detection evident for screening centres in a population-based trial

Background & objectivesThree-dimensional (3D)-mammography (tomosynthesis) may improve breast cancer detection. We examined centre-specific effect of integrated 2D/3D mammography based on the STORM (screening with tomosynthesis or standard mammography) trial.MethodsAsymptomatic women who attended population-based screening through Trento and Verona screening centres were recruited into STORM, a prospective comparison of screen-reading in two sequential phases: 2D-mammography only and integrated 2D/3D mammography. Outcomes were the number and rates of detected cancers and of false positive recalls (FPR), and incremental cancer detection rate (CDR). Paired binary data were compared using Mc Nemar's test.ResultsOf 33 cancers detected in Trento, 21 were detected at both 2D and 2D/3D screening, 12 cancers were detected only with integrated 2D/3D screening compared with none detected at 2D-only screening (P < 0.001). Of the 26 cancers detected in Verona, 18 were detected at both 2D and 2D/3D screening, 8 cancers were detected only with integrated 2D/3D screening compared with none detected at 2D-only screening (P = 0.008). There were no differences between centres in baseline CDR, and incremental CDR attributable to 3D-mammography was similar for Trento (2.8/1000 screens) and for Verona (2.6/1000 screens). Trento had 239 FPR (5.7% of screens): 103 FPR at both screen-readings, 93 FPR only at 2D-mammography compared with 43 FPR only at 2D/3D-mammography (p < 0.001). Verona had 156 FPR (5.2% of screens): 78 FPR at both screen-readings, 48 FPR only at 2D-mammography compared with 30 FPR only at 2D/3D-mammography (p = 0.054). Estimated reduction in FPR proportion had recall been conditional to 2D/3D-mammography-positivity differed between centres (21.0% versus 11.5%; P = 0.02).ConclusionIntegrated 2D/3D-mammography significantly increased cancer detection for both screening services; potential reduction in FPR is likely to differ between centres with those experiencing relatively higher FPR most likely to benefit from 2D/3D-mammography screening.     

Breast cancers detected in only one of two arms of a tomosynthesis (3D-mammography) population screening trial (STORM-2)

The prospective ‘screening with tomosynthesis or standard mammography-2 (STORM-2)’ trial compared mammography screen-reading strategies and showed that each of integrated 2D/3D-mammography or 2Dsynthetic/3D-mammography detected significantly more breast cancers than 2D-mammography alone. This short report describes 13 (from 90) cancers detected in only one of two parallel double-reading arms implemented in STORM-2. Amongst this subset of cases, the majority was invasive cancer ≤16 mm, mostly depicted as irregular masses or distortions. Furthermore, most were detected at 3D-mammography only and predominantly by one reader from double-reading pairs, highlighting that 3D-mammography may enable detection of cancers that are challenging to perceive at routine screening.     

Effect of implementing digital breast tomosynthesis (DBT) instead of mammography on population screening outcomes including interval cancer rates: Results of the Trento DBT pilot evaluation

Background/aimThe Trento screening program transitioned to digital breast tomosynthesis (DBT) screening based on evidence that DBT improves breast cancer (BC) detection compared to mammography; an evaluation of the transition to DBT is reported in this pilot study.MethodsProspective implementation of DBT screening included women aged ≥50 years who attended the Trento program for biennial screening. DBT screening included DBT acquisitions with synthesized 2D-images. A historical cohort of women who attended the program (January 2013–October 2014) and received digital mammography (DM) provided a comparison group. Independent double-reading (with a third arbitrating read for discordance) was used for DBT and DM screening. Screening outcomes included cancer detection rate (CDR/1000 screens), percentage of screens recalled to assessment (recall%), interval cancer rate (ICR/1000 screens) at 2-year follow-up, and screening sensitivity. Rate ratios (RR) and 95% confidence interval (95%CI) examined outcomes for DBT versus DM screening.ResultsFrom women aged 50–69 years who accepted an invitation to screening (October 2014–October 2016) 46,343 comprised the DBT-screened group: amongst these 402 BCs (includes 50 ductal carcinoma in-situ (DCIS)) were detected (CDR 8.67/1000), whereas 205 BCs (includes 33 DCIS) were detected amongst 37,436 DM screens (CDR 5.48/1000) [RR for CDR:1.58 (1.34–1.87)]. Recall% was lower for DBT (2.55%) than DM (3.21%) [RR:0.79 (0.73–0.86)]. Compared to DM, DBT screening increased CDR for stage I-II BC, for all tumour size and grade categories, and for node-negative BC, but did not increase CDR for DCIS. Estimated ICR for DBT was 1.1/1000 whereas ICR for DM was 1.36/1000 [RR:0.81 (0.55–1.19)]. Screening sensitivity was 88.74% for DBT versus 80.08% for DM [RR:1.11 (0.94–1.31)].ConclusionDBT significantly improved early-detection measures but did not significantly reduce ICR (relative to DM screening), suggesting that it could add benefit as well as adding over-detection in population BC screening.     

Breast cancer screening using synthesized two-dimensional mammography: A systematic review and meta-analysis

PurposeWe conducted a systematic review and meta-analysis to compare the screening performance of synthesized mammography (SM) plus digital breast tomosynthesis (DBT) with digital mammography (DM) plus DBT or DM alone.MethodsMedline, Embase, Web of Science, and the Cochrane Library databases were searched from January 2010 to January 2021. Eligible population-based studies on breast cancer screening comparing SM/DBT with DM/DBT or DM in asymptomatic women were included. A random-effect model was used in this meta-analysis. Data were summarized as risk differences (RDs), with 95 % confidence intervals (CIs).ResultsThirteen studies involving 1,370,670 participants were included. Compared with DM/DBT, screening using SM/DBT had similar breast cancer detection rate (CDR) (RD = −0.1/1000 screens, 95 % CI = −0.4 to 0.2, p = 0.557, I² = 0 %), but lower recall rate (RD = −0.56 %, 95 % CI = −1.03 to −0.08, p = 0.022, I² = 90 %) and lower biopsy rate (RD = −0.33 %, 95 % CI = −0.56 to −0.10, p = 0.005, I² = 78 %). Compared with DM, SM/DBT improved CDR (RD = 2.0/1000 screens, 95 % CI = 1.4 to 2.6, p < 0.001, I² = 63 %) and reduced recall rate (RD = −0.95 %, 95 % CI = −1.91 to −0.002, p = 0.049, I² = 99 %). However, SM/DBT and DM had similar interval cancer rate (ICR) (RD = 0.1/1000 screens, 95 % CI = −0.6 to 0.8, p = 0.836, I² = 71 %) and biopsy rate (RD = −0.05 %, 95 % CI = −0.35 to 0.24, p = 0.727, I² = 93 %).ConclusionsScreening using SM/DBT has similar breast cancer detection but reduces recall and biopsy when compared with DM/DBT. SM/DBT improves CDR when compared with DM, but they have little difference in ICR. SM/DBT could replace DM/DBT in breast cancer screening to reduce radiation dose.     

Disparities in the uptake of digital breast tomosynthesis for breast cancer screening: A retrospective cohort study

We present a retrospective cohort study evaluating the utilization and effectiveness of digital breast tomosynthesis (DBT) for breast cancer screening with a focus on racial differences. 46,236 females underwent screening mammography between 4/1/2013 and 3/30/2020, during which there was an increase in DBT utilization from 18.8% in year 1 to 89.6% in year 7. Black and Asian women were significantly less likely to have a screening study with DBT compared to White women. Overall, the DBT group had a lower recall rate (9.1% versus 11.2%, p < 0.001) and higher cancer detection rate (6.0 vs 4.1, p < 0.001) compared to the FFDM group.     

Interval breast cancers in screening: the effect of mammography review method on classification

Surveillance of interval cancers (IC) lacks standardisation of review methodologies. We investigated the extent to which 'informed' or 'blinded' review may affect IC classification. This is a retrospective study of 100 validated screening mammograms (20 IC, 80 negative screens) independently reviewed by six radiologists. Three sequenced review methods with increasing information were used: (1) blinded (no IC information, case mix), (2) partially informed, and (3) fully informed. IC 'screening error' (SE) reports averaged 24% (10-40), 33% (20-55), and 42% (35-50) for phases 1, 2, and 3, while 'minimal signs' (MS) reports averaged 6% (5-15), 10% (10-20), and 20% (15-30), respectively. Negative mammograms classification was MS in 18% (7-39) or SE in 19% (11-29), respectively. MS or SE classification was more likely for method 2 (OR=1.78, p=0.033) and method 3 (OR=3.91, p=0.000) relative to method 1, but no reader effect was evident. Inter-observer agreement in classifying at method 1 was slight (k 0.20), lowest (k 0.06) for MS, and fair (k 0.25) for negative and SE categories. More 'informed' review is more likely to yield an IC classification as MS or SE. Due to expected variability, review methods need standardisation to improve screening quality. Our data support blinded review of IC in mammography screening.     

优化数字乳腺断层摄影曝光条件的体模显像

目的比较数字乳腺断层摄影(DBT)不同摄影条件下对乳腺体模病灶的检出率。方法对ACR-156体模及MPW-01体模进行DBT,使用有机玻璃板组合模拟5个不同厚度,首先采用自动曝光控制模式(AEC)进行曝光,然后保持相同管电压值,管电流设为AEC曝光时的80%、60%、40%和20%。比较不同厚度、不同曝光条件下辐射剂量及病灶检出率。结果随管电流下降,平均腺体剂量和皮肤吸收剂量及总体病灶检出率下降(P均0.01);相同厚度下,管电流降低20%时,肿块样病灶及钙化样病灶检出率下降平缓甚至无明显变化,纤维样病灶检出率下降较明显,管电流降低20%时,各病灶检出率均随管电流下降而下降;厚度增加对肿块样病灶检出率有一定影响。结论乳腺筛查中适当降低管电流可有效减低辐射剂量而不影响病灶检出率。     

Breast Cancers Found with Digital Breast Tomosynthesis: A Comparison of Pathology and Histologic Grade

To compare the pathology and histologic grading of breast cancers detected with digital breast tomosynthesis to those found with conventional digital mammography. The institutional review board approved this study. A database search for all breast cancers diagnosed from June 2012 through December 2013 was performed. Imaging records for these cancers were reviewed and patients who had screening mammography with tomosynthesis as their initial examination were selected. Five dedicated breast imaging radiologists reviewed each of these screening mammograms to determine whether the cancer was visible on conventional digital mammography or whether tomosynthesis was needed to identify the cancer. A cancer was considered mammographically occult if all five radiologists agreed that the cancer could not be seen on conventional digital mammography. The size, pathology and histologic grading for all diagnosed breast cancers were then reviewed. The Mann–Whitney U and Fisher exact tests were utilized to determine any association between imaging findings and cancer size, pathologic type and histologic grade. Sixty‐five cancers in 63 patients were identified. Ten of these cancers were considered occult on conventional digital mammography and detected with the addition of tomosynthesis. These mammographically occult cancers were significantly associated with Nottingham grade 1 histologic pathology (p = 0.02), were smaller (median size: 6 mm versus 10 mm, p = 0.07) and none demonstrated axillary nodal metastases. Breast cancers identified through the addition of tomosynthesis are associated with Nottingham grade 1 histologic pathology and prognostically more favorable than cancers identified with conventional digital mammography alone.     

Preoperative assessment of breast cancer: Multireader comparison of contrast-enhanced MRI versus the combination of unenhanced MRI and digital breast tomosynthesis

PurposeTo compare the sensitivity for breast cancer (BC) and BC size estimation of preoperative contrast-enhanced magnetic resonance imaging (CEMRI) versus combined unenhanced magnetic resonance imaging (UMRI) and digital breast tomosynthesis (DBT).Patients and methodsWe retrospectively included 56 women who underwent DBT and preoperative 1.5 T CEMRI between January 2016–February 2017. Three readers with 2–10 years of experience in CEMRI and DBT, blinded to pathology, independently reviewed CEMRI (diffusion-weighted imaging [DWI], T2-weighted imaging, pre- and post-contrast T1-weighted imaging) and a combination of UMRI (DWI and pre-contrast T1-weighted imaging) and DBT. We calculated per-lesion sensitivity of CEMRI and UMRI + DBT, and the agreement between CEMRI, UMRI and DBT versus pathology in assessing cancer size (Bland-Altman analysis). Logistic regression was performed to assess features predictive of cancer missing.ResultsWe included 70 lesions (64% invasive BC, 36% ductal carcinoma in situ or invasive BC with in situ component). UMRI + DBT showed lower sensitivity (86–89%) than CEMRI (94–100%), with a significant difference for the most experienced reader only (p = 0.008). False-positives were fewer with UMRI + DBT (4–5) than with CEMRI (18–25), regardless of the reader (p = 0.001–0.005). For lesion size, UMRI showed closer limits of agreement with pathology than CEMRI or DBT. Cancer size ≤1 cm was the only independent predictor for cancer missing for both imaging strategies (Odds ratio 8.62 for CEMRI and 19.16 for UMRI + DBT).ConclusionsUMRI + DBT showed comparable sensitivity and less false-positives than CEMRI in the preoperative assessment of BC. UMRI was the most accurate tool to assess cancer size.     

Systematic review of 3D mammography for breast cancer screening

This review investigated the relative performance of digital breast tomosynthesis (DBT) (alone or with full field digital mammography (FFDM) or synthetic digital mammography) compared with FFDM alone for detecting breast cancer lesions in asymptomatic women. A systematic review was carried out according to systematic reviewing principles provided in the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. A protocol was developed a priori. The review was registered with PROSPERO (number CRD42014013949). Searches were undertaken in October 2014. Following selection, five studies were eligible. Higher cancer detection rates were observed when comparing DBT + FFDM with FFDM in two European studies: the summary difference per 1000 screens was 2.43 (95% CI: 1.8 to 3.1). Both European studies found lower false positive rates for individual readers. One found a lower recall rate based on conditional recall. The second study was not designed to compare post-arbitration recall rates between FFDM and DBT + FFDM. One European study presented data on interval cancer rates; sensitivity and specificity for DBT + FFDM were both higher compared to FFDM. One large multicentre US study showed a higher cancer detection rate for DBT + FFDM, while two smaller US studies did not find statistically significant differences. Reductions in recall and false positive rates were observed in the US studies in favour of DBT + FFDM. In comparison to FFDM, DBT, as an adjunct to FFDM, has a higher cancer detection rate, increasing the effectiveness of breast cancer screening. Additional benefits of DBT may also include reduced recalls and, consequently, reduced costs and distress caused to women who would have been recalled.     

Promoters and barriers to mammography screening in multiethnic inner city patients

Introduction

The goal of this study was to understand promoters and barriers to annual mammography screening among multiethnic inner city women aged 40 years and above.

Methods

Women at 4 community health centers were asked to fill out a self-administered survey and divided into 2 groups. Group A consisted of women who had a mammogram in the last 2 years and group B of women who had never had a mammogram or for whom it had been over 2 years since their last mammogram.

Results

One hundred forty-four of 172 (84%) women approached agreed to fill out the survey: 80% self-reported as group A and 20% as group B. Group A women were more likely to have someone recommend they get a mammogram, have a primary care provider (PCP), and have a female PCP. Group B women reported they were “too busy” and would prefer a walk-in mammogram clinic.

Conclusions

Mammography screening remains a public health challenge.     

A single-institution study of 117 pregnancy-associated breast cancers (PABC): Presentation,imaging, clinicopathological data and outcome

BackgroundThis retrospective single-institution study was designed to describe the main clinical, radiological and histological features, as well as the outcome of pregnancy-associated breast cancer (PABC), with a special emphasis on imaging and diagnostic difficulties.Material and methodsWe reviewed all breast cancers diagnosed during pregnancy or during the 12 months following delivery at our institution, between 1993 and 2009. Out of a total of 16,555 new cases of breast cancer observed during this period, 117 PABC (0.7%) were diagnosed.ResultsMean age at diagnosis was 33.7 years. Most cancers (81.2%) were diagnosed after delivery. Intermediate or high family risk was frequent (27.5%). The most common mode of presentation was a palpable mass (89.7%). Mean time to diagnosis was 5.8 months. Sensitivity for mammography was 80.9% and for ultrasound 77%. Most prognostic factors were unfavourable: frequent lymph node involvement (51.8%), high-grade tumours, hormone receptor negativity (45.9%) and HER2 positivity (38.7%). Treatments generally included surgery (61.7% mastectomies), radiotherapy (96%) and chemotherapy (79.6%). Overall 5-year survival was 81.8%.ConclusionPABC is an uncommon but aggressive form of breast cancer and must be considered in the presence of any breast abnormality during pregnancy or the months following delivery. Mammography and ultrasound should both be performed at the slightest clinical suspicion. Radiologists must be aware that masses may lack typical malignant ultrasound characteristics. Biopsies should be largely performed.     

A comparison of breast cancers detected by mass screening and those found in out-patient clinics

We evaluated the results of a mass screening study on breast cancer detection by physical examination alone conducted in Ishikawa Prefecture from 1978 to 1990. The number of cases of breast cancer detected by mass screening was then compared with that found in out-patient clinics during the same period. Breast cancer was detected in 88 of 152,969 women by mass screening, the detection rate being 0.06% for the total study: 0.08% at the initial screening and 0.04% at periodic screenings. Early stage breast cancer was more frequently detected during periodic screenings than at the initial screening or in out-patient clinics. Moreover, although the initial screenings may have identified patients with breast cancer at more advanced stages, the survival was not significantly different. The results of this series led us to conclude that mass screening by physical examination alone may have no impact on the mortality rate of breast cancer.Recipient of a fellowship from the Japanese-Germany Center, Berlin, Germany     

Predictors of malignancy in screen-detected breast masses with indeterminate/equivocal (grade 3) imaging features

Background

The mammographic grading system used by BreastScreen Australia accredited programs requires needle biopsy of lesions with indeterminate features (grade 3). We wished to determine the predictors of malignancy for these common lesions, so as to reduce surgery for benign lesions.

Design

Grade 3 masses assessed between Jan 1996-Dec 2005 are included. New or changing lesions were identified through film review. Imaging, demographic and final outcome data were tabulated. Statistical analysis was performed to determine the predictors of malignancy.

Results

1181 lesions, including 623 new or changing masses are assessed. Of these 98 (8.3%) were malignant. Malignancy was found in 3% first round masses versus 13% of new or changing lesions. Withholding needle biopsy results, interval change (OR 2.85, p = 0.0001), increasing age (p = 0.0001) and diameter were independent predictors of malignancy, lesion diameter having an inverse relationship with malignancy.Once needle biopsy results were included, this parameter became the sole predictor of malignancy as other factors lost significance in a multivariate model.

Conclusion

Surgical biopsy is not indicated in well-sampled grade 3 masses with benign needle biopsy results. Surgery is valuable for diagnosis or treatment of the remaining such masses without benign needle biopsy results.     

Overdiagnosis and overtreatment associated with breast cancer mammography screening: A simulation study with calibration to population-based data

ObjectivesThe magnitude of overdiagnosis of breast cancer associated with mammography screening remains controversial because of methodological issues. The objective of this study was to quantify overdiagnosis and overtreatment associated with a population-based screening programme, taking into account lead time and uncertainty concerning baseline incidence of breast cancers.Material and methodsA simulation model was developed to replicate incidence and detection rates of breast cancer observed in the Isère Département, France. The parameters of the model were estimated using an approximate Bayesian computation method.ResultsFor women aged 50–74 years during the 2007–2010 period, overdiagnosis of non-progressive breast cancers accounted for 17.0% (95% credibility interval (CI): 2.5%–35.5%) of all in situ cancers diagnosed, 5.5% (95% CI: 0.8%–9.8%) of all invasive cancers diagnosed, and 20.3% (95% CI: 3.0%–38.9%) of in situ and 13.0% (95% CI: 2.2%–23.3%) of invasive screen detected breast cancers. The estimates of overdiagnosis due to competitive causes of death were 1.0% (95% CI: 0.2%–%1.7) and 1.1% (95% CI: 0.6%–1.7%) for all in situ and invasive cancers diagnosed, respectively, and 1.3% (95% CI: 0.2%–2.0%) and 2.6% (95% CI: 1.4%–4.0%) of all in situ and invasive screen detected breast cancers, respectively.Among 1000 screen-detected cancers in 2010, 155 (95% CI: 27–284), 134 (95% CI: 10–242) and 140 (95% CI: 25–254) women underwent breast conserving surgery, lymph node dissection and radiation therapy for overdiagnosed cancers, respectively.ConclusionOur estimates of overdiagnosis should be balanced against the reduction of breast cancer mortality to assess the value of breast cancer screening programme.     

Digital breast tomosynthesis and contrast‐enhanced dual‐energy digital mammography alone and in combination compared to 2D digital synthetized mammography and MR imaging in breast cancer detection and classification

To compare diagnostic performance of contrast‐enhanced dual‐energy digital mammography (CEDM) and digital breast tomosynthesis (DBT) alone and in combination compared to 2D digital mammography (MX) and dynamic contrast‐enhanced MRI (DCE‐MRI) in women with breast lesions. We enrolled 100 consecutive patients with breast lesions (BIRADS 3‐5 at imaging or clinically suspicious). CEDM, DBT, and DCE‐MRI 2D were acquired. Synthetized MX was obtained by DBT. A total of 134 lesions were investigated on 111 breasts of 100 enrolled patients: 53 were histopathologically proven as benign and 81 as malignant. Nonparametric statistics and receiver operating characteristic (ROC) curve were performed. Two‐dimensional synthetized MX showed an area under ROC curve (AUC) of 0.764 (sensitivity 65%, specificity 80%), while AUC was of 0.845 (sensitivity 80%, specificity 82%) for DBT, of 0.879 (sensitivity 82%, specificity 80%) for CEDM, and of 0.892 (sensitivity 91%, specificity 84%) for CE‐MRI. DCE‐MRI determined an AUC of 0.934 (sensitivity 96%, specificity 88%). Combined CEDM with DBT findings, we obtained an AUC of 0.890 (sensitivity 89%, specificity 74%). A difference statistically significant was observed only between DCE‐MRI and CEDM (P = .03). DBT, CEDM, CEDM combined to tomosynthesis, and DCE‐MRI had a high ability to identify multifocal and bilateral lesions with a detection rate of 77%, 85%, 91%, and 95% respectively, while 2D synthetized MX had a detection rate for multifocal lesions of 56%. DBT and CEDM have superior diagnostic accuracy of 2D synthetized MX to identify and classify breast lesions, and CEDM combined with DBT has better diagnostic performance compared with DBT alone. The best results in terms of diagnostic performance were obtained by DCE‐MRI. Dynamic information obtained by time‐intensity curve including entire phase of contrast agent uptake allows a better detection and classification of breast lesions.     

Reducing harms from treatment. Sixteen years of surgery of the axilla for screen-detected breast cancers in Italy

ObjectivesAvailable evidence on axillary surgery has accumulated dramatically in the last two decades in favor of less invasive care. The aim of this paper is to study 16-years trends in the surgical management of the axilla in a large population-based data set of screen-detected breast cancers in Italy and to document at what extent recommendations have been adopted in actual clinical care.Material and methodsThis is a retrospective cohort study documenting the surgical management of the axilla in primary breast cancer patients over time. We retrieved from the Italian database of screen-detected cancers 41213 cases diagnosed in women aged 50–69 between years 2000 and 2015 in twelve Italian Regions.ResultsIn pN0 cases, an increasing trend (p < 0.001) in the number of patients who received sentinel lymph node biopsy (SLNB) as the only axillary staging procedure was observed. In pN + cases SLNB was the only staging procedure in an increasing number of patients (p < 0.001) especially since the publication of the ACOSOG-Z0011 paper. In ductal carcinoma in situ (DCIS) SLNB was more frequent in mastectomies and in high grade and large lesions. However, 45% of low grade, small DCIS over the whole time period had some form of axillary surgery.ConclusionThis large series of screen-detected cases documents a strong time trend in the direction of reducing axillary surgery and hence potential harms from treatment. The continuing practice of SLNB in low risk DCIS is of concern in an era of increasing awareness towards overdiagnosis and overtreatment.     

中国女性乳腺癌群体筛查与机会性筛查的比较研究

目的比较乳腺癌群体筛查和机会性筛查两种模式的人群特点、筛查阳性率、乳腺癌检出率、早期乳腺癌比例及筛查费用。方法本研究为前瞻性多中心队列研究,研究时间为2014年1月1日至2016年12月31日。分别入组群体筛查和机会性筛查受试者,填写调查问卷表,并进行每年1次乳腺体检及乳腺超声检查,共完成3轮筛查,采用χ²检验、Fisher确切概率法和Wilcoxon秩和检验比较两组人群的特点及筛查结果。结果共入组受试者20080人。群体筛查组完成3轮筛查的人数分别为9434人(100%)、8111人(85.98%)和3940人(41.76%);机会性筛查组分别为10646人(100%)、6209人(58.32%)和2988人(28.07%)。机会性筛查组中产后哺乳时间<3个月(1275/9796比1061/8860,χ²=4.597,P=0.032)、未生育(850/10646比574/9434,χ²=27.400,P<0.01)、有流产史(6384/10646比5062/9434,χ²=81.232,P<0.01)、绝经后(2776/10646比2217/9434,χ²=17.757,P<0.01)、口服避孕药>6个月(171/10646比77/9434,χ²=25.593,P<0.01)及一级亲属乳腺癌阳性家族史(464/10646比236/9434,χ²=51.257,P<0.01)比例高于群体筛查组。机会性筛查组筛查阳性率(514/10646比128/9434,χ²=194.736,P<0.01)、乳腺癌检出率(158/10646比13/9434,χ²=107.374,P<0.01)和活检阳性率(158/452比13/87,χ²=13.491,P<0.01)高于群体筛查组。群体筛查组早期乳腺癌(0期和Ⅰ期)比例高于机会性筛查组(10/12比66/141,χ²=5.902,P=0.015)。群体筛查组发现每1例乳腺癌的平均费用为215038元,是机会性筛查组15799元的13.6倍。机会性筛查组基层医院的活检阳性率低于大型医院(79/267比79/185,χ²=8.267,P=0.004),而群体筛查组两者无明显差异(6/37比7/50,χ²=0.082,P=0.774)。结论乳腺癌筛查可以早期发现乳腺癌。机会性筛查具有受试者乳腺癌高危因素比例高、筛查阳性率高、乳腺癌检出率高、活检阳性率高、筛查费用低的特点。但是,机会性筛查的早期乳腺癌比例低于群体筛查,基层医院开展机会性筛查时活检阳性率较低。两种筛查模式各有优势,需要有机结合,取长补短。     

Overview of radiomics in breast cancer diagnosis and prognostication

Diagnosis of early invasive breast cancer relies on radiology and clinical evaluation, supplemented by biopsy confirmation. At least three issues burden this approach: a) suboptimal sensitivity and suboptimal positive predictive power of radiology screening and diagnostic approaches, respectively; b) invasiveness of biopsy with discomfort for women undergoing diagnostic tests; c) long turnaround time for recall tests. In the screening setting, radiology sensitivity is suboptimal, and when a suspicious lesion is detected and a biopsy is recommended, the positive predictive value of radiology is modest. Recent technological advances in medical imaging, especially in the field of artificial intelligence applied to image analysis, hold promise in addressing clinical challenges in cancer detection, assessment of treatment response, and monitoring disease progression. Radiomics include feature extraction from clinical images; these features are related to tumor size, shape, intensity, and texture, collectively providing comprehensive tumor characterization, the so-called radiomics signature of the tumor. Radiomics is based on the hypothesis that extracted quantitative data derives from mechanisms occurring at genetic and molecular levels. In this article we focus on the role and potential of radiomics in breast cancer diagnosis and prognostication.