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目的比较胶片摄影与数字摄影在乳腺癌筛查中对于临床相关癌症的检出率。材料与方法研究经过地区医学伦理委员会批准,不需要知情同意书。在荷兰每两年1次的筛查项目中,全国广泛使用数字乳腺摄影之前,有3个筛查区进行了数字乳腺摄影。最初的筛查检查中,每侧乳腺进行内外侧斜位和头尾位摄影。而在随后的检查中,常规进行内外侧斜位摄影。如果有需要才进行头尾位摄影。将最初和随后的乳腺胶片摄影和数字摄影的筛查结果,包括放射学与病理学特点进行比较。结果 2003—2007年间共进行1198493例筛查,18896例进行了复查(胶片摄影:最初的筛查为2.6%,随后的检查为1.3%;数字摄影:最初的筛查为4.4%,随后的检查为2.1%;两者P<0.001)。6410例妇女诊断为乳腺癌(胶片摄影:最初的检查每1000名妇女的检出率为5.6,随后的检出率为5.2;数字摄影:最初的检查中每1000名妇女的检出率为6.8,随后的检出率6.1;P=0.02和P<0.001)。不论哪次筛查,数字乳腺摄影均可发现更多的导管原位癌。在随后的检查中,可发现更多的浸润癌,特别是伴有微钙化者(P=0.047)。两种成像方法中发现的导管原位癌和浸润癌的组织病理学分化等级是相似的。但是,在随后的检查中数字乳腺摄影能检出更多高级别的导管原位癌(P=0.013)。结论在对人群的乳腺筛查项目中,乳腺数字摄影对于导管原位癌和浸润癌的检测显著优于胶片摄影。采用数字乳腺摄影进行筛查,低级别导管原位癌的检出并没有增加的迹象,表明有可能存在过度诊断。相反的,数字乳腺摄影似乎增加了高级别导管原位癌的检测。
Objective To compare the detection rates of clinically relevant cancers in breast screening with film photography and digital photography. Materials and Methods Approved by the Regional Medical Ethics Committee, no informed consent is required. In the Netherlands biweekly screening program, digital mammography was performed in three screening areas prior to the widespread use of digital mammography throughout the country. In the initial screening examination, each side of the mammary gland was photographed obliquely and head-to-tail. In the subsequent examination, routine internal and external oblique photography. If necessary, head and tail photography. The initial and subsequent screening of breast film photography and digital photography, including radiological and pathological features were compared. RESULTS: A total of 1,199,943 tests were performed during 2003-2007 and 18,896 were reviewed (film photography: 2.6% for initial screenings and 1.3% for subsequent screens; digital photography: 4.4% for initial screens and subsequent exams Was 2.1%; both P <0.001). 6410 women diagnosed with breast cancer (film photography: initial screening rate was 5.6 per 1,000 women and the subsequent detection rate was 5.2; digital photography: the detection rate per 1000 women in the initial examination was 6.8 , Followed by a detection rate of 6.1; P = 0.02 and P <0.001). Regardless of the screening, digital mammography can detect more ductal carcinoma in situ. In subsequent examinations, more invasive carcinomas were found, especially those with microcalcifications (P = 0.047). Histopathologic grade of ductal carcinoma in situ and invasive carcinoma found in both imaging modalities were similar. However, digital mammography detected more advanced ductal carcinoma in situ in subsequent exams (P = 0.013). Conclusions In breast screening programs in the population, digital breast imaging was significantly superior to film photography for ductal carcinoma in situ and invasive carcinoma. Screening with digital mammography shows no sign of increase in low-grade ductal carcinoma in situ, suggesting that there may be an overdiagnosis. In contrast, digital mammography appears to increase the detection of high-grade ductal carcinoma in situ.