Radiologische Tumorzeichen von Mammakarzinomen im UICC-Stadium I: Subanalyse der randomisierten kontrollierten Studie TOSYMA

Zusammenfassung

Ziel

Die randomisierte kontrollierte, multizentrische TOSYMA-Studie zeigte eine Überlegenheit der Kombination aus digitaler Brust-Tomosynthese und synthetischer Mammografie (DBT+SM) gegenüber der digitalen Mammografie (DM) hinsichtlich der Detektionsrate invasiver Mammakarzinome im Stadium UICC I. In dieser Subanalyse wurden die mammografischen Tumorzeichen der in jedem Studienarm entdeckten Mammakarzinome im Stadium I, stratifiziert nach dem histologischen Grad, verglichen.

Materialien und Methoden

Diese Subanalyse inkludierte im DBT+SM-Arm 49 462 Frauen und im DM-Arm 49 669 Frauen nach 1:1 Randomisierung von 7/2018 bis 12/2020. Die in der Konsensuskonferenz dokumentierten mammografischen Auffälligkeiten wurden für Mammakarzinome im Stadium UICC I basierend auf verschiedenen Tumorzeichen (wie Herdbefunde, Mikroverkalkungen, Architekturstörungen bzw. deren Kombination) erhoben. Berechnet wurden die Detektionsraten (pro 10 000 gescreenter Frauen) mit Differenzierung des Grads 1 von den Graden 2 oder 3.

Ergebnisse

G1-Karzinome wurden mit DBT+SM bei 6,5/10 000 gescreenter Frauen allein durch Herdbefunde (+1,5/10 000 versus DM), bei 2,4/10 000 (+1,6/10 000) durch Architekturstörungen und bei 1,2/10 000 (+0,8/10 000) durch Mikroverkalkungen detektiert. Mehrere Tumorzeichen (Kombinationen) lagen bei 7,9/10 000 (+6,1/10 000) vor. Grad-2- oder -3-Karzinome wurden mit DBT+SM bei 13,7/10 000 allein durch Herdbefunde (+2,6/10 000 versus DM), bei 4,9/10 000 durch Mikroverkalkungen (+2,3/10 000) und bei 3,6/10 000 durch Architekturstörungen (+2,0/10 000) detektiert. Kombinationen von Tumorzeichen lagen bei 10,1/10 000 (+6,3/10 000) vor.

Schlussfolgerung

Die Detektionsrate von Mammakarzinomen im UICC-Stadium I ist im DBT+SM-Screening höher als im DM-Screening: Dazu tragen sowohl singuläre Tumorzeichen als auch ihre Kombinationen bei. Dabei werden im DBT+SM-Screening vor allem häufiger Mammakarzinome Grad 2 oder 3 im UICC-Stadium I entdeckt, was überwiegend auf Kombinationen radiologischer Tumorzeichen zurückzuführen ist.

Kernaussagen

• DBT+SM detektiert mehr Grad-2- oder -3-UICC I-Mammakarzinome als DM.

• Dieser Zugewinn an Detektionsrate resultiert vor allem aus Kombinationen einzelner Tumorzeichen.

• Nahezu hälftig beruht dieser Zugewinn auf singulären Zeichen: Herdbefunden, Mikroverkalkungen und Architekturstörungen.

Abstract

Purpose

The randomized controlled, multicenter TOSYMA study showed a superiority of the combination of digital breast tomosynthesis and synthetic mammography (DBT+SM) over digital mammography (DM) in the detection rate of invasive breast cancer at stage UICC I. In this subanalysis, we compared the mammographic tumor signs of UICC I stage breast cancers detected in each study arm and stratified according to histological grade.

Materials and Methods

This subanalysis included 49,462 women in the DBT+SM arm and 49,669 women in the DM arm after 1:1 randomization from July 2018 to December 2020. The mammographic abnormalities documented at the consensus conference were collected for breast cancers in stage UICC I based on various tumor signs (such as masses, microcalcifications, architectural distortions, or their combinations). The detection rates (per 10,000 screened women) were calculated with differentiation of grade 1 and grade 2 or 3 cancers.

Results

Grade 1 cancers were detected using DBT+SM in 6.5/10,000 screened women only by masses (+1.5/10,000 versus DM), in 2.4/10,000 (+1.6/10,000) by architectural distortions, and in 1.2/10,000 (+0.8/10,000) by microcalcifications. Combinations of tumor signs were present in 7.9/10,000 (+6.1/10,000) screened women. Grade 2 or 3 cancers were detected by DBT+SM in 13.7/10,000 by masses (+2.6/10,000 versus DM), in 4.9/10,000 by microcalcifications (+2.3/10,000), and in 3.6/10,000 by architectural distortions (+2.0/10,000). Combinations were present in 10.1/10,000 (+6.3/10,000) screened women.

Conclusion

In DBT+SM screening, the detection rate of UICC I breast cancers is higher compared to DM: both, individual tumor signs and their combinations contribute to this finding. The detection rate of UICC I grade 2 or 3 cancers is higher in DBT+SM screening than in DM screening mainly due to the combination of tumor signs.

Key Points

• DBT+SM detects more grade 2 or 3-UICC I breast cancers than DM.

• This increase in detection rate results mainly from a combination of tumor signs.

• Nearly half of the increase relates to individual signs: masses, microcalcifications, and architectural distortions.

Schlüsselwörter

Brust - digitale Radiografie - Screening - Brustkrebs - digitale Brust-Tomosynthese - synthetische Mammografie

Keywords

breast - digital radiography - screening - breast cancer - digital breast tomosynthesis - digital mammography

Publication History

Received: 02 September 2024

Accepted after revision: 17 February 2025

Article published online:
04 June 2025

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