背景 目前尚不清楚乳腺致密女性的乳腺超声筛查结果是否随乳腺癌风险水平的变化而变化。目的 评估对具有致密乳房和不同估计乳腺癌风险水平的女性患者的美国筛查结果。材料和方法 这项回顾性观察性研究使用了 2014 年 1 月至 2020 年 10 月期间在三个乳腺癌监测联盟 (BCSC) 登记处的 24 个放射机构对乳房异质或极其致密的女性患者进行的美国筛查检查的数据。主要结局是癌症检出率、假阳性活检推荐率和活检的阳性预测值 (PPV3)。使用已建立的 BCSC 风险预测模型对参与者进行风险分类，该模型估计 6 年晚期乳腺癌风险和 5 年浸润性乳腺癌风险。使用广义线性模型评估高风险类别与低风险类别或平均风险类别的差异。结果 总共包括来自 26 489 名女性患者（筛查时平均年龄，53.9 岁 ± 9.0 [SD]）的 34 791 次美国筛查检查。每 1000 次检查的总体癌症检出率为 2.0 (95% CI: 1.6, 2.4)，并且 6 年晚期乳腺癌高风险患者与低风险或平均风险患者相比较高 (5.5 [95% CI: 3.5, 8.6] vs分别为 1.3 [95% CI：1.0，1.8]；P = .003）。每 1000 次检查的总体假阳性活检建议率为 29.6 (95% CI: 22.6, 38.6)，并且在高风险或低或平均 6 年晚期乳腺癌风险患者中较高 (37.0 [95% CI: 28.2, 48.4) ] vs 28.1 [95% CI: 20.9, 37.8]，分别为 P = .04)。总体 PPV3 为 6.9%（975 人中的 67 人；95% CI：5.3、8.9），并且在 6 年晚期癌症风险高的患者与低或平均的患者中较高（15.0% [100 人中的 15 人；95% CI：9.9， 22.2] vs 4.9% [615 中的 30；95% CI：3.3，7.2]；P = 0.01）。 5 年浸润性乳腺癌风险也观察到了类似的结果模式。结论 补充超声筛查的癌症检出率和 PPV3 随着晚期和浸润性乳腺癌的估计风险而增加。 © RSNA，2024 本文提供补充材料。另请参阅本期 Helbich 和 Kapetas 的社论。

Background It is unclear whether breast US screening outcomes for women with dense breasts vary with levels of breast cancer risk. Purpose To evaluate US screening outcomes for female patients with dense breasts and different estimated breast cancer risk levels. Materials and Methods This retrospective observational study used data from US screening examinations in female patients with heterogeneously or extremely dense breasts conducted from January 2014 to October 2020 at 24 radiology facilities within three Breast Cancer Surveillance Consortium (BCSC) registries. The primary outcomes were the cancer detection rate, false-positive biopsy recommendation rate, and positive predictive value of biopsies performed (PPV3). Risk classification of participants was performed using established BCSC risk prediction models of estimated 6-year advanced breast cancer risk and 5-year invasive breast cancer risk. Differences in high- versus low- or average-risk categories were assessed using a generalized linear model. Results In total, 34 791 US screening examinations from 26 489 female patients (mean age at screening, 53.9 years ± 9.0 [SD]) were included. The overall cancer detection rate per 1000 examinations was 2.0 (95% CI: 1.6, 2.4) and was higher in patients with high versus low or average risk of 6-year advanced breast cancer (5.5 [95% CI: 3.5, 8.6] vs 1.3 [95% CI: 1.0, 1.8], respectively; P = .003). The overall false-positive biopsy recommendation rate per 1000 examinations was 29.6 (95% CI: 22.6, 38.6) and was higher in patients with high versus low or average 6-year advanced breast cancer risk (37.0 [95% CI: 28.2, 48.4] vs 28.1 [95% CI: 20.9, 37.8], respectively; P = .04). The overall PPV3 was 6.9% (67 of 975; 95% CI: 5.3, 8.9) and was higher in patients with high versus low or average 6-year advanced cancer risk (15.0% [15 of 100; 95% CI: 9.9, 22.2] vs 4.9% [30 of 615; 95% CI: 3.3, 7.2]; P = .01). Similar patterns in outcomes were observed by 5-year invasive breast cancer risk. Conclusion The cancer detection rate and PPV3 of supplemental US screening increased with the estimated risk of advanced and invasive breast cancer. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Helbich and Kapetas in this issue.