乳腺癌筛查项目中的间期癌(2007-2018 年):特征和预后。

Radiologia Pub Date : 2024-11-01 Epub Date: 2024-11-30 DOI:10.1016/j.rxeng.2023.03.009
P Alonso Bartolomé, P Merino Rasillo, S Sánchez Gómez, E Herrera Romero, E Ortega García, M Sánchez Movellán, P Muñoz Cacho, A Vega Bolívar
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引用次数: 0

摘要

背景与目的分析在 2007 年至 2018 年期间共六轮基于人群的乳腺癌筛查计划中诊断出的筛查癌和间期癌的放射学和组织学特征:我们分析了研究期间每两年接受一次数字乳腺X光检查的50-69岁女性中筛查出的1395例癌症和诊断出的300例间期癌症。筛查乳房 X 光照片只读一次。为了对间期癌进行分类,我们在每一轮检查结束后进行回顾性复查(盲阅后进行非盲阅),记录放射学检查结果、乳腺密度、组织学特征、表型和手术治疗:156例(52%)间期癌被归类为真正的间期癌,62例(20.5%)为假阴性,39例(13%)为极小征象,29例(9.5%)为隐匿性病变,14例(5%)无法归类。回顾性分析发现,在假阴性病例中,最常见的放射学发现是肿块/不对称(64%)、钙化(16%)和变形(13%);在征兆极少的病例中,最常见的放射学发现是肿块/不对称(58%)和钙化(31%)。筛查发现的癌症与间隔期癌症的组织学特征存在明显差异:T1a-b[占间期癌的 9%,占筛查发现癌的 34%,P 结论:T1a-b[占间期癌的 9%,占筛查发现癌的 34%:约 20% 的间隔期癌症在筛查乳房 X 光照片中明显可见。间期癌最常见的放射学发现是不对称/肿块。与筛查发现的癌症相比,间期癌的诊断处于更晚期,因此更多情况下采用乳房切除术进行治疗。复查间期癌对于筛查项目的质量控制至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Interval carcinomas in a breast cancer screening program (2007-2018): Characteristics and prognosis.

Background and aims: To analyze the radiologic and histologic characteristics of screening and interval cancers diagnosed in the period comprising 2007 through 2018 in a total of six rounds of a population-based breast cancer screening program.

Material and methods: We analyzed 1395 carcinomas detected at screening and 300 interval carcinomas diagnosed in women aged 50-69 years old who underwent digital mammography every two years during the study period. Screening mammograms were read once. To classify the interval carcinomas, we retrospectively reviewed (blind reading followed by unblinded reading) at the end of each round, recording the radiologic findings, breast density, histologic characteristics, phenotype, and surgical treatment.

Results: The interval carcinomas were classified as true interval cancers in 156 (52%) cases, false-negatives in 62 (20.5%), minimal signs in 39 (13%), occult lesions in 29 (9.5%), and impossible to classify in 14 (5%). Retrospectively, the most common radiologic findings in the false-negative cases were mass/asymmetry (64%), calcifications (16%), and distortion (13%); the most common radiologic findings in the cases with minimal signs were mass/asymmetry (58%) and calcifications (31%). There were significant differences in the histologic characteristics between cancers detected at screening and interval cancers: T1a-b [9% of the interval cancers vs. 34% of those detected at screening, P < .001]; T1c [30% of the interval cancers vs. 44% of those detected at screening P < .001], T2 or greater [61% of the interval cancers vs. 22% of those detected at screening P < .001], and the degree of axillary involvement [45% of the interval cancers vs. 27% of those detected at screening, P < .001]. There were also significant differences between cancers detected at screening and interval cancers in the proportion of cases with more aggressive subtypes (HER2+ and triple-negative): [38.5% of the interval cancers vs. 23% of those detected at screening, P < .001]. A significantly higher proportion of interval cancers were treated with mastectomies [80% vs. 67% of those detected at screening, P < .001].

Conclusions: About 20% of interval cancers were evident on screening mammograms. The most common radiologic finding in interval cancers was asymmetry/mass. Interval cancers are diagnosed at a more advanced stage than cancers identified at screening, so they sre more often treated by mastectomy. Reviewing interval cancers is essential for quality control in screening programs.

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