Abstract：
OBJECTIVE: Women with a personal history of breast cancer have an increased risk of subsequent breast malignancy and may benefit from more sensitive surveillance than conventional mammography (MG). We previously reported outcomes for first surveillance episode using contrast-enhanced mammography (CEM), demonstrating higher sensitivity and comparable specificity to MG. We now report CEM performance for subsequent surveillance.
METHODS: A retrospective study of 1,190 women in an Australian hospital setting undergoing annual surveillance following initial surveillance CEM between June 2016 and December 2022. Outcome measures were recall rate, cancer detection rate, contribution of contrast to recalls, false positive rate, interval cancer rate and characteristics of surveillance detected and interval cancers.
RESULTS: 2,592 incident surveillance episodes were analysed, of which 93% involved contrast-based imaging. Of 116 (4.5%) recall episodes, 40/116 (34%) recalls were malignant (27 invasive; 13 ductal carcinoma in situ), totalling 15.4 cancers per 1000 surveillance episodes. 55/116 (47%) recalls were contrast-directed including 17/40 (43%) true positive recalls. Tumour features were similar for contrast-directed recalls and other diagnoses. 8/9 (89%) of contrast-directed invasive recalls were Grade 2-3, and 5/9 (56%) were triple negative breast cancers. There were two symptomatic interval cancers (0.8 per 1000 surveillance episodes, program sensitivity 96%).
CONCLUSIONS: Routine use of CEM in surveillance of women with PHBC led to an increase in the detection of clinically significant malignant lesions, with a low interval cancer rate compared to previous published series. Compared to mammographic surveillance, contrast-enhanced mammography increases the sensitivity of surveillance programs for women with PHBC.
METHODS: A retrospective study of 1,190 women in an Australian hospital setting undergoing annual surveillance following initial surveillance CEM between June 2016 and December 2022. Outcome measures were recall rate, cancer detection rate, contribution of contrast to recalls, false positive rate, interval cancer rate and characteristics of surveillance detected and interval cancers.
RESULTS: 2,592 incident surveillance episodes were analysed, of which 93% involved contrast-based imaging. Of 116 (4.5%) recall episodes, 40/116 (34%) recalls were malignant (27 invasive; 13 ductal carcinoma in situ), totalling 15.4 cancers per 1000 surveillance episodes. 55/116 (47%) recalls were contrast-directed including 17/40 (43%) true positive recalls. Tumour features were similar for contrast-directed recalls and other diagnoses. 8/9 (89%) of contrast-directed invasive recalls were Grade 2-3, and 5/9 (56%) were triple negative breast cancers. There were two symptomatic interval cancers (0.8 per 1000 surveillance episodes, program sensitivity 96%).
CONCLUSIONS: Routine use of CEM in surveillance of women with PHBC led to an increase in the detection of clinically significant malignant lesions, with a low interval cancer rate compared to previous published series. Compared to mammographic surveillance, contrast-enhanced mammography increases the sensitivity of surveillance programs for women with PHBC.
摘要：
目的：有乳腺癌个人病史的女性，其后续乳腺恶性肿瘤的风险增加，并且可能受益于比常规乳腺X线照相术（MG）更敏感的监测。我们先前报告了使用对比增强乳房X线照相术（CEM）的首次监测发作的结果，表现出更高的敏感性和与MG相当的特异性。我们现在报告后续监测的CEM性能。
方法：对澳大利亚一家医院的1,190名妇女进行回顾性研究，该研究在2016年6月至2022年12月期间进行了初步CEM监测后进行了年度监测。结果指标是召回率，癌症检出率,对比对回忆的贡献，假阳性率,间隔癌症率和监测检测和间隔癌症的特征。
结果：分析了2,592次事件监测事件，其中93%涉及基于对比的成像。在116次(4.5%)召回事件中，40/116（34％）召回是恶性的（27个浸润性；13个导管原位癌），每1000次监测发作总计15.4例癌症。55/116（47％）的召回是针对对比的，包括17/40（43％）的真阳性召回。对比剂召回和其他诊断的肿瘤特征相似。8/9（89％）的造影剂侵入性召回是2-3级，5/9（56％）是三阴性乳腺癌。有两种有症状的间期癌症（每1000次监测发作0.8次，程序灵敏度96%)。
结论：在监测女性PHBC中常规使用CEM导致临床上有意义的恶性病变的检测增加，与以前发表的系列相比，间隔期癌症发生率较低。与乳房X光检查相比，对比增强乳房X线照相术提高了PHBC女性监测方案的敏感性.
方法：对澳大利亚一家医院的1,190名妇女进行回顾性研究，该研究在2016年6月至2022年12月期间进行了初步CEM监测后进行了年度监测。结果指标是召回率，癌症检出率,对比对回忆的贡献，假阳性率,间隔癌症率和监测检测和间隔癌症的特征。
结果：分析了2,592次事件监测事件，其中93%涉及基于对比的成像。在116次(4.5%)召回事件中，40/116（34％）召回是恶性的（27个浸润性；13个导管原位癌），每1000次监测发作总计15.4例癌症。55/116（47％）的召回是针对对比的，包括17/40（43％）的真阳性召回。对比剂召回和其他诊断的肿瘤特征相似。8/9（89％）的造影剂侵入性召回是2-3级，5/9（56％）是三阴性乳腺癌。有两种有症状的间期癌症（每1000次监测发作0.8次，程序灵敏度96%)。
结论：在监测女性PHBC中常规使用CEM导致临床上有意义的恶性病变的检测增加，与以前发表的系列相比，间隔期癌症发生率较低。与乳房X光检查相比，对比增强乳房X线照相术提高了PHBC女性监测方案的敏感性.
