背景
乳腺影像报告和数据系统 (BI-RADS) 3 类 (BR3)（可能是良性的）乳房 X 光检查评估保留用于已知恶性可能性为 2% 或更低的影像学检查结果。
目的
确定年龄、发现类型和先前的乳房 X 线照相术对国家乳房 X 光检查数据库 (NMD) 中 BR3 发现的癌症发生率的影响。
材料和方法
这项符合 HIPAA 的回顾性队列机构审查委员会豁免研究评估了从 2009 年 1 月至 2018 年 3 月的诊断评估和 471 个 NMD 设施中从筛查性乳房 X 光检查和 BR3 评估中召回的女性。对于活检或影像学随访至少 2 年的女性，仅包括第一次 BR3 发生。有乳腺癌病史或在初始 BR3 评估时接受活检的女性被排除在外。女性以 10 年为间隔按年龄分层。计算每个年龄组的癌症发生率，使用（对于假定的新发现）和不使用先前的乳房 X 线照相比较，并在可用的情况下按病变类型计算。使用加权年龄分箱进行线性回归以评估组间差异；磷 < .05 表示存在显着差异。
结果
共有 1 380 652 (18.2%) 名女性在筛查乳房 X 光检查后被召回，其中 157 130 (11.4%) 在筛查后 90 天内接受了 BR3 评估。其中，43628 名女性（中位年龄为 55 岁；年龄范围为 25-90 岁）进行了足够的随访以进行分析。癌症发生率随着年龄十分位数的增加而增加，从 30-39 岁女性的 0.51%（1167 人中的 6 人）到 80-90 岁女性的 4.63%（885 人中的 41 人）不等；59.7 岁及之后的基线发现癌症发生率超过 2%，推定的新发现在 53.6 岁及之后癌症发生率超过 2%，尽管对分期分布没有影响。基线 BR3 肿块的癌症发生率为 2111 个中的 10 个 (0.47% [95% CI: 0.24, 0.90]) 与 3003 个中的 47 个 (1.57% [95% CI: 1.16, 2.09]) 与先前的比较 ( P< .001); 基线钙化的癌症发生率为 929 例中的 8 例 (0.86% [95% CI: 0.40, 1.76])，而 2999 例中的 84 例 (2.80% [95% CI: 2.23, 3.47]) 与先前的比较 ( P < .001)。同龄女性与未进行过先前比较的女性之间的癌症发生率差异为 0.51%（95% CI：0.16, 0.86）（P = .006）。
结论
对于 60 岁或以上的女性，癌症发生率超过了 2% 的阈值，在 80-89 岁的女性中达到了 4.6%。乳房成像报告和数据系统 3 发现，在同一年龄，有过先前比较的女性的癌症发生率高于未进行过比较的女性。
©北美放射学会，2021
本文提供了在线补充材料。
"点击查看英文标题和摘要"
Cancer Yield Exceeds 2% for BI-RADS 3 Probably Benign Findings in Women Older Than 60 Years in the National Mammography Database
Background
Breast Imaging Reporting and Data System (BI-RADS) category 3 (BR3) (probably benign) mammographic assessments are reserved for imaging findings known to have likelihood of malignancy of 2% or less.
Purpose
To determine the effect of age, finding type, and prior mammography on cancer yield for BR3 findings in the National Mammography Database (NMD).
Materials and Methods
This HIPAA-compliant retrospective cohort institutional review board–exempt study evaluated women recalled from screening mammography followed by BR3 assessment at diagnostic evaluation from January 2009 to March 2018 and from 471 NMD facilities. Only the first BR3 occurrence was included for women with biopsy or imaging follow-up of at least 2 years. Women with a history of breast cancer or who underwent biopsy at time of initial BR3 assessment were excluded. Women were stratified by age in 10-year intervals. Cancer yield was calculated for each age group, with (for presumed new findings) and without prior mammographic comparison, and by lesion type, where available. Linear regression with weighted-age binning was performed to assess for differences between groups; P < .05 was indicative of a significant difference.
Results
A total of 1 380 652 (18.2%) women were recalled after screening mammography, of whom 157 130 (11.4%) were given a BR3 assessment within 90 days after screening. Of these, 43 628 women (median age, 55 years; age range, 25–90 years) had adequate follow-up for analysis. Cancer yield increased with increasing age decile, ranging from 0.51% (six of 1167) in women aged 30–39 years to 4.63% (41 of 885) in women aged 80–90 years; cancer yield exceeded 2% at and after age 59.7 years for baseline findings and at and after age 53.6 years for presumed new findings, although there was no effect on stage distribution. Cancer yield for baseline BR3 masses was 10 of 2111 (0.47% [95% CI: 0.24, 0.90]) versus 47 of 3003 (1.57% [95% CI: 1.16, 2.09]) with prior comparisons (P < .001); cancer yield for baseline calcifications was eight of 929 (0.86% [95% CI: 0.40, 1.76]) versus 84 of 2999 (2.80% [95% CI: 2.23, 3.47]) with prior comparisons (P < .001). Difference in cancer yield was 0.51% (95% CI: 0.16, 0.86) between women with and women without prior comparison at the same age (P = .006).
Conclusion
Cancer yield exceeded the 2% threshold for women aged 60 years or older and reached 4.6% for women aged 80–89 years. Breast Imaging Reporting and Data System 3 findings in women with a prior comparison had higher cancer yield than in those without a prior comparison at the same age.
© RSNA, 2021
Online supplemental material is available for this article.
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