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CC BY-NC-ND 4.0 · Senologie - Zeitschrift für Mammadiagnostik und -therapie 2024; 21(03): 219-226
DOI: 10.1055/a-2287-2854
Original Research

Gesteigerte Entdeckung relevanter Mammakarzinome durch DBT im Mammografie-Screening?

Article in several languages: English | deutsch
Stefanie Weigel
1   Clinic for Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
,
Veronika Weyer-Elberich
2   Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
,
Hans-Werner Hense
3   Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
,
Thomas Decker
1   Clinic for Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
,
Joachim Gerß
4   Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
,
Walter Heindel
1   Clinic for Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
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Zusammenfassung

Einleitung

Screening mit digitaler Brust-Tomosynthese plus synthetischer Mammografie (DBT+SM) steigert im Vergleich zur digitalen Mammografie (DM) die Entdeckung invasiver Mammakarzinome. Da eine Senkung der Brustkrebssterblichkeit wesentlich auf der Detektion von Mammakarzinomen der histologischen Grade 2 oder 3 beruht, wurde ein Vergleich der Detektionsraten invasiver Mammakarzinome (iCDR) stadienunabhängig von den Graden 2 oder 3, unter Berücksichtigung der Brustdichte, nach Screening mit DBT+SM gegenüber DM vorgenommen.

Material und Methodik

Die 1:1 randomisierte, multizentrische TOSYMA-Studie wurde von 7/2018 bis 12/2020 im deutschen Mammografie-Screening-Programm durchgeführt. Die vorliegende explorative Subanalyse umfasste 49479 Teilnehmerinnen im DBT+SM-Arm und 49689 Teilnehmerinnen im DM-Arm mit vollständiger Dokumentation, einschließlich visueller Dichtekategorisierung (A/B: nicht dichtes Parenchym, C/D: dichtes Parenchym).

Ergebnisse

Die iCDR der Grade 2 oder 3 betrug mit DBT+SM 5,1 pro 1000 gescreenter Frauen vs. 3,6 ‰ mit DM (Differenz +1,5 ‰). Bei nicht dichtem Parenchym lag die entsprechende DBT+SM-Rate bei 4,5 ‰ (Differenz zur DM +1,3 ‰), bei dichtem Parenchym bei 5,7 ‰ (Differenz zur DM +1,7 ‰).

Die iCDR des Grades 1 betrug mit DBT+SM 2,1 ‰ (+0,8 ‰ vs. DM). Bei nicht dichtem Parenchym lag die entsprechende DBT+SM-Rate bei 1,7 ‰ (Differenz zur DM +0,7 ‰), bei dichtem Parenchym bei 2,6 ‰ (Differenz zur DM +1,0 ‰).

Schlussfolgerung

Im Screening mit DBT+SM liegen die Detektionsraten für alle Mammakarzinome Grad 2 oder 3 höher als mit DM. Bei dichtem Brustparenchym zeigen sich höhere entsprechende Detektionsraten und Differenzen der Detektionsraten als bei nicht dichtem Parenchym.

Diese Detektionsraten, wie auch ihre Differenzen, sind mit DBT+SM und mit DM konsistent höher als für Karzinome mit Grad 1. Die explorativen Analysen dieser großen randomisierten Studie deuten darauf hin, dass der Einsatz von DBT+SM im Screening zu einer gesteigerten Entdeckung prognoserelevanter Mammakarzinome führt.

Schlüsselwörter

Brustkrebs - Mammografie-Screening - Digitale Brust-Tomosynthese - Brustdichte - Tumorgrad


Publication History

Article published online:
13 September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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