Breast screening using 2D-mammography or integrating digital breast tomosynthesis (3D-mammography) for single-reading or double-reading - Evidence to guide future screening strategies

详细信息    查看全文

• 作者：Nehmat Houssami^a ; ^{nehmath@med.usyd.edu.au" class="auth_mail} ; Petra Macaskill^a ; Daniela Bernardi^b ; Francesca Caumo^c ; Marco Pellegrini^b ; Silvia Brunelli^c ; Paola Tuttobene^b ; Paola Bricolo^c ; Carmine Fant&ograve ; ^b ; Marvi Valentini^b ; Stefano Ciatto^b ; ^c ; ^&dagger ;
• 关键词：Breast cancer ; Digital breast tomosynthesis ; Interval cancer ; Mammography ; Population screening ; Screen-reading
• 刊名：European Journal of Cancer
• 出版年：July 2014
• 年：2014
• 卷：50
• 期：10
• 页码：1799-1807
• 全文大小：378 K

文摘

We compared detection measures for breast screening strategies comprising single-reading or double-reading using standard 2D-mammography or 2D/3D-mammography, based on the ‘screening with tomosynthesis or standard mammography’ (STORM) trial.

Methods

STORM prospectively examined screen-reading in two sequential phases, 2D-mammography alone and integrated 2D/3D-mammography, in asymptomatic women participating in Trento and Verona (Northern Italy) population-based screening services. Outcomes were ascertained from assessment and/or excision histology or follow-up. For each screen-reading strategy we calculated the number of detected and non-detected (including interval) cancers, cancer detection rates (CDRs), false positive recall (FPR) measures and incremental CDR relative to a comparator strategy. We estimated the false:true positive (FP:TP) ratio and sensitivity of each mammography screening strategy. Paired binary data were compared using McNemar’s test.

Results

Amongst 7292 screening participants, there were 65 (including six interval) breast cancers; estimated first-year interval cancer rate was 0.82/1000 screens (95% confidence interval (CI): 0.30–1.79/1000). For single-reading, 35 cancers were detected at both 2D and 2D/3D-mammography, 20 cancers were detected only with 2D/3D-mammography compared with none at 2D-mammography alone (p < 0.001) and 10 cancers were not detected. For double-reading, 39 cancers were detected at 2D-mammography and 2D/3D-mammography, 20 were detected only with 2D/3D-mammography compared with none detected at 2D-mammography alone (p < 0.001) and six cancers were not detected. The incremental CDR attributable to 2D/3D-mammography (versus 2D-mammography) of 2.7/1000 screens (95% CI: 1.6–4.2) was evident for single and for double-reading. Incremental CDR attributable to double-reading (versus single-reading) of 0.55/1000 screens (95% CI: −0.02–1.4) was evident for 2D-mammography and for 2D/3D-mammography. Estimated FP:TP ratios showed that 2D/3D-mammography screening strategies had more favourable FP to TP trade-off and higher sensitivity, applying single-reading or double-reading, relative to 2D-mammography screening.

Conclusion

The evidence we report warrants rethinking of breast screening strategies and should be used to inform future evaluations of 2D/3D-mammography that assess whether or not the estimated incremental detection translates into improved screening outcomes such as a reduction in interval cancer rates.