Abstract：
OBJECTIVE: The randomized TOmosynthesis plus SYnthesized MAmmography (TOSYMA) screening trial has shown that digital breast tomosynthesis plus synthesized mammography (DBT + SM) is superior to digital mammography (DM) in invasive breast cancer detection varying with breast density. On the other hand, the overall average glandular dose (AGD) of DBT is higher than that of DM. Comparing the DBT + SM and DM trial arm, we analyzed here the mean AGD and their determinants per breast density category and related them to the respective invasive cancer detection rates (iCDR).
METHODS: TOSYMA screened 99,689 women aged 50 to 69 years. Compression force, resulting breast thickness, the calculated AGD obtained from each mammography device, and previously published iCDR were used for comparisons across breast density categories in the two trial arms.
RESULTS: There were 196,622 exposures of 49,227 women (DBT + SM) and 197,037 exposures of 49,132 women (DM) available for analyses. Mean breast thicknesses declined from breast density category A (fatty) to D (extremely dense) in both trial arms. However, while the mean AGD in the DBT + SM arm declined concomitantly from category A (2.41 mGy) to D (1.89 mGy), it remained almost unchanged in the DM arm (1.46 and 1.51 mGy, respectively). In relative terms, the AGD elevation in the DBT + SM arm (64.4% (A), by 44.5% (B), 27.8% (C), and 26.0% (D)) was lowest in dense breasts where, however, the highest iCDR were observed.
CONCLUSIONS: Women with dense breasts may specifically benefit from DBT + SM screening as high cancer detection is achieved with only moderate AGD elevations.
CONCLUSIONS: TOSYMA suggests a favorable constellation for screening with digital breast tomosynthesis plus synthesized mammography (DBT + SM) in dense breasts when weighing average glandular dose elevation against raised invasive breast cancer detection rates. There is potential for density-, i.e., risk-adapted population-wide breast cancer screening with DBT + SM.
CONCLUSIONS: Breast thickness declines with visually increasing density in digital mammography (DM) and digital breast tomosynthesis (DBT). Average glandular doses of DBT decrease with increasing density; digital mammography shows lower and more constant values. With the smallest average glandular dose difference in dense breasts, DBT plus SM had the highest difference in invasive breast cancer detection rates.
METHODS: TOSYMA screened 99,689 women aged 50 to 69 years. Compression force, resulting breast thickness, the calculated AGD obtained from each mammography device, and previously published iCDR were used for comparisons across breast density categories in the two trial arms.
RESULTS: There were 196,622 exposures of 49,227 women (DBT + SM) and 197,037 exposures of 49,132 women (DM) available for analyses. Mean breast thicknesses declined from breast density category A (fatty) to D (extremely dense) in both trial arms. However, while the mean AGD in the DBT + SM arm declined concomitantly from category A (2.41 mGy) to D (1.89 mGy), it remained almost unchanged in the DM arm (1.46 and 1.51 mGy, respectively). In relative terms, the AGD elevation in the DBT + SM arm (64.4% (A), by 44.5% (B), 27.8% (C), and 26.0% (D)) was lowest in dense breasts where, however, the highest iCDR were observed.
CONCLUSIONS: Women with dense breasts may specifically benefit from DBT + SM screening as high cancer detection is achieved with only moderate AGD elevations.
CONCLUSIONS: TOSYMA suggests a favorable constellation for screening with digital breast tomosynthesis plus synthesized mammography (DBT + SM) in dense breasts when weighing average glandular dose elevation against raised invasive breast cancer detection rates. There is potential for density-, i.e., risk-adapted population-wide breast cancer screening with DBT + SM.
CONCLUSIONS: Breast thickness declines with visually increasing density in digital mammography (DM) and digital breast tomosynthesis (DBT). Average glandular doses of DBT decrease with increasing density; digital mammography shows lower and more constant values. With the smallest average glandular dose difference in dense breasts, DBT plus SM had the highest difference in invasive breast cancer detection rates.
摘要：
目的：在乳腺密度不同的浸润性乳腺癌检测中，随机TOmosynthesizedmammography（TOSYMA）筛选试验表明，数字乳腺断层合成加合成乳腺X线照相术（DBT+SM）优于数字乳腺X线照相术（DM）。另一方面,DBT的总体平均腺体剂量（AGD）高于DM。比较DBT+SM和DM试验臂，我们在此分析了每个乳腺密度类别的平均AGD及其决定因素,并将它们与各自的浸润性癌症检出率(iCDR)相关联.
方法：TOSYMA筛查了99,689名50至69岁的女性。压缩力,导致乳房厚度，从每个乳房X线照相术设备获得的计算AGD，和先前发表的iCDR用于两个试验组的乳腺密度类别之间的比较.
结果：可用于分析的有49,227名女性（DBT+SM）的196,622次暴露和49,132名女性（DM）的197,037次暴露。在两个试验组中,平均乳房厚度从乳房密度类别A(脂肪)下降到D(极致密)。然而,而DBT+SM臂的平均AGD从A类(2.41mGy)下降到D类(1.89mGy)，它在DM臂中几乎保持不变(1.46和1.51mGy，分别)。相对而言,DBT+SM臂中的AGD高程(64.4%(A)，由44.5%（B），27.8%（C），和26.0%(D))在致密乳房中最低，然而,观察到最高的iCDR。
结论：乳房致密的女性可能特别受益于DBT+SM筛查，因为只有适度的AGD升高才能实现高癌症检测。
结论：当权衡平均腺体剂量升高与提高的浸润性乳腺癌检出率时，TOSYMA建议在致密乳房中使用数字乳房断层合成加合成乳房X线摄影（DBTSM）进行筛查。有可能产生密度-，即，使用DBT+SM进行适应风险的全人群乳腺癌筛查。
结论：在数字乳腺X线摄影（DM）和数字乳腺断层合成（DBT）中，乳腺厚度随视觉密度增加而下降。DBT的平均腺体剂量随着密度的增加而减少；数字乳房X线照相术显示出较低且更恒定的值。在致密乳房中，平均腺体剂量差异最小，DBT加SM在浸润性乳腺癌检出率中差异最大。
方法：TOSYMA筛查了99,689名50至69岁的女性。压缩力,导致乳房厚度，从每个乳房X线照相术设备获得的计算AGD，和先前发表的iCDR用于两个试验组的乳腺密度类别之间的比较.
结果：可用于分析的有49,227名女性（DBT+SM）的196,622次暴露和49,132名女性（DM）的197,037次暴露。在两个试验组中,平均乳房厚度从乳房密度类别A(脂肪)下降到D(极致密)。然而,而DBT+SM臂的平均AGD从A类(2.41mGy)下降到D类(1.89mGy)，它在DM臂中几乎保持不变(1.46和1.51mGy，分别)。相对而言,DBT+SM臂中的AGD高程(64.4%(A)，由44.5%（B），27.8%（C），和26.0%(D))在致密乳房中最低，然而,观察到最高的iCDR。
结论：乳房致密的女性可能特别受益于DBT+SM筛查，因为只有适度的AGD升高才能实现高癌症检测。
结论：当权衡平均腺体剂量升高与提高的浸润性乳腺癌检出率时，TOSYMA建议在致密乳房中使用数字乳房断层合成加合成乳房X线摄影（DBTSM）进行筛查。有可能产生密度-，即，使用DBT+SM进行适应风险的全人群乳腺癌筛查。
结论：在数字乳腺X线摄影（DM）和数字乳腺断层合成（DBT）中，乳腺厚度随视觉密度增加而下降。DBT的平均腺体剂量随着密度的增加而减少；数字乳房X线照相术显示出较低且更恒定的值。在致密乳房中，平均腺体剂量差异最小，DBT加SM在浸润性乳腺癌检出率中差异最大。
