间隔性乳腺癌与筛查发现的乳腺癌：一项回顾性队列研究
Interval Breast Cancers Versus Screen Detected Breast Cancers: A Retrospective Cohort Study
DOI 原文链接
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影响因子:3.9
分区:医学2区 / 核医学2区
发表日期:2023 Sep
作者:
Emily B Ambinder, Emerson Lee, Derek L Nguyen, Anna J Gong, Orli J Haken, Kala Visvanathan
DOI:
10.1016/j.acra.2023.01.007
摘要
乳腺X线摄影筛查可以检测出大部分乳腺癌，但仍有女性在年度乳腺X线检测之间被诊断出乳腺癌。我们的目标是识别区分筛查检测乳腺癌与间隔性乳腺癌的特征。对我们机构在2013年7月1日至2020年6月30日期间进行的所有筛查乳腺X线摄影（n=211,517）进行了回顾。纳入在筛查后一年内确诊乳腺癌的患者，并将其分为两组：筛查检测癌组和间隔性癌组。采用卡方检验、费舍尔精确检验和学生t检验对这些组的特征进行比较。共纳入1,232例患者（平均年龄64±11岁）。筛查乳腺X线摄影的敏感性为92%（1,136例筛查检测癌，96例间隔性癌）。两组在患者年龄、种族及乳腺癌既往史方面差异无统计学意义（p > 0.05）。间隔性癌患者更常表现为高密度乳腺组织（75/96=78% vs 694/1136=61%，p < 0.001）。与筛查检测癌相比，间隔性癌更常为原发肿瘤第二期或更高级别（41/96=43% vs 139/1136=12%，p < 0.001）以及区域淋巴结第一期或更高级别（21/96=22% vs 132/1136=12%，p=0.003）。间隔性癌更常为三阴性（16/77=21% vs 48/813=6%，p < 0.001），且具有较高的Ki67增殖指数（28/45=62% vs 188/492=38%，p=0.002）。乳腺X线筛查对乳腺癌的检测具有较高敏感性（92%）。间隔性癌与高密度乳腺组织相关，且其分期更高，分子特征也较筛查检测癌不利。
Abstract
Mammographic screening detects most breast cancers but there are still women diagnosed with breast cancer between annual mammograms. We aim to identify features that differentiate screen detected breast cancers from interval breast cancer.All screening mammograms (n = 211,517) performed 7/1/2013-6/30/2020 at our institution were reviewed. Patients with breast cancer diagnosed within one year of screening were included and divided into two distinct groups: screen detected cancer group and interval cancer group. Characteristics in these groups were compared using the chi square test, fisher test, and student's T test.A total of 1,232 patients were included (mean age 64 +/- 11). Sensitivity of screening mammography was 92% (1,136 screen detected cancers, 96 interval cancers). Patient age, race, and personal history of breast cancer were similar between the groups (p > 0.05). Patients with interval cancers more often had dense breast tissue (75/96 = 78% versus 694/1136 = 61%, p < 0.001). Compared to screen detected cancers, interval cancers were more often primary tumor stage two or higher (41/96 = 43% versus 139/1136 = 12%, p < 0.001) and regional lymph node stage one or higher (21/96 = 22% versus 132/1136 = 12%, p = 0.003). Interval cancers were more often triple negative (16/77 = 21% versus [48/813 = 6%], p < 0.001) with high Ki67 proliferation indices (28/45 = 62% versus 188/492 = 38%, p = 0.002).Mammographic screening had high sensitivity for breast cancer detection (92%). Interval cancers were associated with dense breast tissue and had higher stage with less favorable molecular features compared to screen detected cancers.