乳腺癌筛查中的数字乳房断层合成：道德观点
Digital breast tomosynthesis in breast cancer screening: an ethical perspective
影响因子:4.50000
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
摘要
尽管数字乳房断层合成比数字乳房X线摄影具有更高的敏感性，并且至少具有高特异性，但数字乳房摄影仍然是进行乳房X线摄影筛查的最常见方法。同时，乳房X线摄影系统现在被传递“ DBT就绪”，可用于数字乳房摄影或数字乳房合成。在本文中，我们询问鉴于其灵敏度较低，在道德上允许使用此类设备进行数字乳房X线摄影。我们认为这不是，并且在道德上需要使用其DBT就绪设备进行诊所进行数字乳房间隙筛查，只要有可能。我们的论点依赖于数字乳房合成的比较与数字乳房摄影图像质量的假设改善之间的比较。关键相关性声明：当使用DBT就绪设备用于数字乳房X线摄影筛查时，女性可能会因数字乳房断层合成的筛查而失去筛查的好处；我们认为这种做法在道德上是有问题的。要点：数字乳房合成的乳腺癌病例比数字乳腺X线摄影更多。乳房X线摄影设备通常可用于筛查数字乳房合成和数字乳房摄影。在可能的情况下，诊所在道德上需要使用现有设备与数字乳房合成而不是数字乳房X线摄影进行筛查。
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.