A prospective comparative trial of adjunct screening with tomosynthesis or ultrasound in women with mammography-negative dense breasts (ASTOUND-2)
| Autor: | Nicoletta Gandolfo, Daniele La Forgia, Alberto Tagliafico, Jacopo Nori, Manuela Durando, Maria Pia Sormani, Nehmat Houssami, Alessio Signori, Francesca Caumo, Massimo Calabrese, Ilan Rosenberg, Giovanna Mariscotti, Francesca Valdora |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Adult
Cancer Research medicine.medical_specialty Breast Neoplasms False-positive recall Sensitivity and Specificity Asymptomatic 1117 Public Health and Health Services 030218 nuclear medicine & medical imaging 03 medical and health sciences Population screening Imaging Three-Dimensional 0302 clinical medicine McNemar's test Breast cancer Interquartile range Ultrasound medicine Humans Mammography False Positive Reactions 1112 Oncology and Carcinogenesis Prospective Studies Early Detection of Cancer Aged medicine.diagnostic_test business.industry Biopsy Needle Middle Aged medicine.disease Cancer detection Tomosynthesis Confidence interval Tumor Burden Breast density Cancer detection False-positive recall Population screening Tomosynthesis Ultrasound Oncology Lymphatic Metastasis 030220 oncology & carcinogenesis Breast density Radiographic Image Interpretation Computer-Assisted Female Ultrasonography Mammary Radiology medicine.symptom Tomography X-Ray Computed business |
| Zdroj: | European Journal of Cancer |
| Popis: | Background Increased risk of breast cancer (BC) and increased risk of an interval BC at mammography screening are associated with high mammographic density. Adjunct imaging detects additional BCs not detected at mammography screening in women with dense breasts. Aim The aim is to estimate the incremental cancer detection rate (CDR) and false-positive recall for each of tomosynthesis and ultrasound, as adjunct screening modalities in women with mammography-negative dense breasts. Methods A multicentre prospective comparative trial of adjunct screening with tomosynthesis or ultrasound in women with mammography-negative dense breasts (ASTOUND-2) recruited asymptomatic women attending Italian breast screening services. All participants had independently interpreted tomosynthesis and ultrasound. Outcomes were ascertained from excision histopathology or completed assessment. Paired binary data were compared using McNemar's test. Results We recruited 5300 screening participants with median age of 50 (interquartile range 43–79) years who had negative mammography and dense breasts (April 2015–September 2017). Adjunct screening detected 29 additional BCs (27 invasive, 2 in situ): 12 detected on both tomosynthesis and ultrasound, 3 detected only on tomosynthesis, 14 detected only on ultrasound. Incremental CDR for tomosynthesis (+15 cancers) was 2.83/1000 screens (95% confidence interval [CI]: 1.58–4.67) versus ultrasound (+26 cancers) with an incremental CDR of 4.90/1000 screens (95% CI: 3.21–7.19), P = 0.015. Mean size of these cancers was 14.2 mm (standard deviation: 7.8 mm), and six had nodal metastases. Incremental false-positive recall was 1.22% (95% CI: 0.91%–1.49%) and differed significantly between tomosynthesis (0.30%) and ultrasound (1.0%), P Conclusions Ultrasound detected more BCs but caused more false positives than tomosynthesis, underscoring trade-offs in screening outcomes when adjunct imaging is used for screening dense breasts. |
| Databáze: | OpenAIRE |
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