数字乳腺断层合成在乳腺癌筛查中的伦理视角
Digital breast tomosynthesis in breast cancer screening: an ethical perspective
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影响因子:4.5
分区:医学2区 Top / 核医学2区
发表日期:2024 Aug 26
作者:
Simon Rosenqvist, Johan Brännmark, Magnus Dustler
DOI:
10.1186/s13244-024-01790-w
摘要
尽管数字乳腺断层合成（DBT）具有比数字乳腺摄影（数字X线摄影）更高的敏感性，并且特异性至少相当，但数字乳腺摄影仍然是最常用的乳腺筛查方法。同时，乳腺摄影系统已被设计为“DBT就绪”，可用于数字乳腺摄影或数字乳腺断层合成。在本文中，我们探讨在敏感性较低的情况下，是否在伦理上允许使用此类设备进行数字乳腺摄影。我们认为不允许，并且诊所有伦理责任在实际条件允许时，使用其“DBT就绪”设备进行数字乳腺断层合成筛查。我们的论点基于数字乳腺断层合成与假设的数字乳腺摄影图像质量改善之间的比较。关键声明：如果使用DBT就绪设备进行数字乳腺摄影，女性可能会失去使用数字乳腺断层合成筛查的益处；我们认为此做法具有伦理问题。要点：数字乳腺断层合成比数字乳腺摄影发现更多乳腺癌病例。乳腺摄影设备通常可以同时用于数字乳腺断层合成和数字乳腺摄影。在条件允许时，诊所有伦理责任使用现有设备进行数字乳腺断层合成筛查，而非数字乳腺摄影。
Abstract
Although digital breast tomosynthesis has higher sensitivity than digital mammography and at least as high specificity, digital mammography remains the most common method for conducting mammographic screening. At the same time, mammography systems are now delivered "DBT-ready" and can be used for either digital mammography or digital breast tomosynthesis. In this paper, we ask whether it is ethically permissible to use such equipment for digital mammography, given its lower sensitivity. We argue it is not, and that clinics are ethically required to use their DBT-ready equipment to screen with digital breast tomosynthesis whenever this is practically possible. Our argument relies on a comparison between digital breast tomosynthesis and a hypothesized improvement in the image quality of digital mammography. CRITICAL RELEVANCE STATEMENT: Women may lose out on the benefits of screening with digital breast tomosynthesis when DBT-ready equipment is used to screen with digital mammography; we argue that this practice is ethically problematic. KEY POINTS: Digital breast tomosynthesis finds more cases of breast cancer than digital mammography. Mammography equipment can often be used to screen with both digital breast tomosynthesis and digital mammography. When they can, clinics are ethically required to use existing equipment to screen with digital breast tomosynthesis instead of digital mammography.