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.

Autor: Bernardi D; Breast Imaging and Screening Unit, Department of Radiology, Humanitas Research Hospital, Milano, Italy., Gentilini MA; Servizio Epidemiologia Clinica e Valutativa, Azienda Provinciale Servizi Sanitari (APSS) Trento, Italy., De Nisi M; Servizio Epidemiologia Clinica e Valutativa, Azienda Provinciale Servizi Sanitari (APSS) Trento, Italy., Pellegrini M; U.O. Senologia Clinica e Screening Mammografico, Department of Diagnostics, Ospedale di Trento, Azienda Provinciale Servizi Sanitari (APSS) Trento, Italy., Fantò C; U.O. Senologia Clinica e Screening Mammografico, Department of Diagnostics, Ospedale di Trento, Azienda Provinciale Servizi Sanitari (APSS) Trento, Italy., Valentini M; U.O. Senologia Clinica e Screening Mammografico, Department of Diagnostics, Ospedale di Trento, Azienda Provinciale Servizi Sanitari (APSS) Trento, Italy., Sabatino V; U.O. Senologia Clinica e Screening Mammografico, Department of Diagnostics, Ospedale di Trento, Azienda Provinciale Servizi Sanitari (APSS) Trento, Italy., Luparia A; AOU Città della Salute e della Scienza di Torino, S.S.D. Senologia di Screening, Torino, Italy., Houssami N; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia. Electronic address: nehmat.houssami@sydney.edu.au.
Jazyk: angličtina
Zdroj: Breast (Edinburgh, Scotland) [Breast] 2020 Apr; Vol. 50, pp. 135-140. Date of Electronic Publication: 2019 Sep 30.
DOI: 10.1016/j.breast.2019.09.012
Abstrakt: Background/aim: The 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.
Methods: Prospective 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.
Results: From 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)].
Conclusion: DBT 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.
(Copyright © 2019 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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