HEALTH OF WOMAN. 2017.8(124):108–115

Дикан І. М., Божок С. М., Гурандо А. В., Козаренко Т. М.
ДУ «Інститут ядерної медицини та променевої діагностики НАМН України», м. Київ

У статті проаналізовано дані наукових публікацій щодо сучасних аспектів діагностики захворювань грудних залоз (ГЗ) за допомогою похідної технології від цифрової мамографії (Full-Field Digital Mammography – FFDM) – томосинтезу (Digital Breast tomosynthesis – DBT) та його переваги і недоліки порівняно зі стандартними мамографічними дослідженнями у візуалізації новоутворень ГЗ, мікрокальцинатів, деформацій матриксу та асиметрій. Головними перевагами DBT є визначення характеристик пухлин та виявлення деформацій матриксу, які не візуалізуються на FFDM та аналоговій мамографії (стандартна мамографія – CМ).
DBT дозволяє нівелювати артефакти сумації при FFDM, які призводять до гіпердіагностики, покращує точність діагностики приблизно на 7%, знижує кількість повторних викликів зі скринінгу від 17% до 38% для пухлин без мікрокальцинатів, може зменшити кількість біопсій приблизно на 39% завдяки кращій деталізації пухлини, покращує виявлення раку ГЗ (РГЗ) на 8% при менших розмірах і на більш ранніх стадіях.
Характеристика згрупованих мікрокальцинатів за допомогою DBT до сьогодні все ще залишається неоднозначною та суперечливою і потребує подальших досліджень.
Уперше в Україні технологія DBT була застосована наприкінці 2014 року у Державній установі «Інститут ядерної медицини та променевої діагностики НАМН України» у відділенні мамології та загальної рентгенології, де була встановлена мамографічна система Selenia® Dimensions® system’s Genius™ 3D MAMMOGRAPHY™ з опцією DBT фірми Hologic, США.
У результаті аналізу наукової літератури статистично доведено, що цифровий томосинтез є необхідною опцією в алгоритмі діагностики захворювань ГЗ.
Ключові слова: цифрова мамографія, цифровий томосинтез грудних залоз, УЗД грудних залоз, МРТ грудних залоз, Selenia Hologic, деформації матриксу, згруповані мікрокальцинати, рак грудної залози.

Література:
1. Імітація раку локальною асиметрією грудної залози. Клінічний випадок  / Є.М. Божок, А.В. Гурандо // Лучевая диагностика. Лучевая Терапия – 2017. – № 2 – С. 68–73.

2. A comparison of the accuracy of film-screen mammography, full-field digital mammography, and digital breast tomosynthesis. / Michell MJ, Iqbal A, Wasan RK, [et al.] // Clin. Radiol. – 2012. – Vol. 67. – P. 976–81. https://doi.org/10.1016/j.crad.2012.03.009; PMid:22625656

3. American College of Radiology ACR Appropriateness Criteria Palpable Breast Masses / Harvey JA, Mahoney MC, Newell MS, [et al.] // J Am Coll Radiol. – 2013. – Vol. 10 (10) – P. 742–9. https://doi.org/10.1016/j.jacr.2013.06.013; PMid:24091044

4. Assessing radiologist performance using combined digital mammography and breast tomosynthesis compared with digital mammography alone: results of a multicenter, multireader trial./ Rafferty EA, Park JM, Philpotts LE, [et al.] // Radiology – 2013. – Vol .266(1). – P. 104–13. https://doi.org/10.1148/radiol.12120674

5. Automated detection of microcalcification clusters for digital breast tomosynthesis using projection data only: a preliminary study./ Reiser I, Nishikawa RM, Edwards AV, [et al.] // Med Phys. – 2008. – Vol. 35 – P. 1486–1493. https://doi.org/10.1118/1.2885366; PMid:18491543 PMCid:PMC2811555

6. Baker JA. Breast tomosynthesis: state of the art and review of the literature./ Baker JA, Lo JY. // Acad Radiol. – 2011. – Vol. 18 – P. 1298–1310. https://doi.org/10.1016/j.acra.2011.06.011; PMid:21893296

7. Breast Imaging Reporting and Data System: ACR BI-RADS—breast imaging atlas, 4th ed. / D’Orsi CJ, Mendelson EB, Ikeda DM, [et al.] // Reston, VA: American College of Radiology. – 2003. PMCid:PMC3146363

8. Breast surgical specimen radiographs: how reliable are they?/ Britton P, Sonoda L, Yamamoto A, [et al.] // Eur J Radiol. – 2011. – Vol. 79 – P. 245–249. https://doi.org/10.1016/j.ejrad.2010.02.012; PMid:20303687

9. Breast tomosynthesis and digital mammography: a comparison of breast cancer visibility and BIRADS classification in a population of cancers with subtle mammographic findings./ Andersson I, Ikeda D, Zackrisson S, [et al.] // European Radiology – 2008. – Vol. 18(12). – P. 2817–25. https://doi.org/10.1007/s00330-008-1076-9; PMid:18641998

10. Calcifications in the breast and digital breast tomosynthesis. / Kopans D, Gavenonis S, Halpern E, Moore R. // Breast J. – 2011. – Vol. 17 – P. 638–644. https://doi.org/10.1111/j.1524-4741.2011.01152.x; PMid:21906207

11. Castronovo V, Bellahcene A. Evidence that breast cancer associated microcalcifications are mineralized malignant cells./ Castronovo V, Bellahcene A // Int J Oncol. – 1998. – Vol. 12 – P. 305–308. https://doi.org/10.3892/ijo.12.2.305

12. Characterisation of microcalcification clusters on 2D digital mammography (FFDM) and digital breast tomosynthesis (DBT): does DBT underestimate microcalcification clusters? results of a multicentre study. / Tagliafico A, Mariscotti G, Durando M, [et al.] // Eur Radiol. – 2015. – Vol. 25 – P. 9–14. https://doi.org/10.1007/s00330-014-3402-8; PMid:25163902

13. Characterization of benign and malignant breast masses by digital breast tomosynthesis mammography. / Helvie MA, Hadjiiski L, Goodsitt MM, [et al.] // Radiological Society of North America 94th Scientific Assembly and Annual Meeting; Chicago, IL. – 2008.

14. Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. / Berg WA, Blume JD, Cormack JB, [et al.] // JAMA. – 2008. – Vol. 299 – P. 2151–2163. https://doi.org/10.1001/jama.299.18.2151; PMid:18477782 PMCid:PMC2718688

15. Comparison between two-dimensional synthetic mammography reconstructed from digital breast tomosynthesis and full-field digital mammography for the detection of T1 breast cancer. / Choi JS, Han BK, Ko EY, [et al.]// EurRadiol. – 2016. – Vol. 26(8) – P. 2538–46. https://doi.org/10.1007/s00330-015-4083-7

16. Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. / Skaane P, Bandos AI, Gullien R, [et al.] // Radiology. – 2013. – Vol. 267 – P. 47–56. https://doi.org/10.1148/radiol.12121373; PMid:23297332

17. Comparison of digital mammography and digital breast tomosynthesis in the detection of architectural distortion. / Dibble EH, Lourenco AP, Baird GL, [et al.] // Eur Radiol. – 2017 Jul. 14 – P.1–8. https://doi.org/10.1007/s00330-017-4968-8.

18. Computation of the glandular radiation dose in digital tomosynthesis of the breast./ Sechopoulos I, Suryanarayanan S, Vedantham S, [et al.] // Med Phys. – 2007. – Vol. 34 (1) – P. 221–232. https://doi.org/10.1118/1.2400836; PMid:17278508 PMCid:PMC4280100

19. Dance DR. Estimation of mean glandular dose for breast tomosynthesis: factors for use with the UK, European and IAEA breast dosimetry protocols. / Dance DR, Young KC, van Engen RE. // Phys Med Biol. – 2011. – Vol. 56 (2) – P. 453–471. https://doi.org/10.1088/0031-9155/56/2/011; PMid:21191150

20. Destounis SV. Preliminary clinical experience with digital breast tomosynthesis in the visualization of breast microcalcifications. / Destounis SV, Arieno AL, Morgan RC. // J Clin Imaging Sci. – 2013. – Vol. 3. – P. 65. https://doi.org/10.4103/2156-7514.124099; PMid:24605260 PMCid:PMC3935251

21. Detection and classification of calcifications on digital breast tomosynthesis and 2D digital mammography: a comparison. / Spangler ML, Zuley ML, Sumkin JH, [et al.] // AJR Am J Roentgenol. – 2011. – Vol. 196 – P. 320–324. https://doi.org/10.2214/AJR.10.4656; PMid:21257882

22. Developing Asymmetries at Mammography: A Multimodality Approach to Assessment and Management./ Allyson L. Chesebro, MD, Nicole S. Winkler, MD, Robin L. Birdwell, MD [et al.]// Radiographics. – 2016. – Vol. 36(2) – P. 322–34. https://doi.org/10.1148/rg.2016150123; PMid:26963449

23. Diagnostic performance of digital versus film mammography for breast-cancer screening. / Pisano ED, Gatsonis C, Hendrick E, [et al.] // N Engl J Med. – 2005. – Vol. 353 – P. 1773–1783. https://doi.org/10.1056/NEJMoa052911; PMid:16169887

24. Digital breast tomosynthesis: initial experience in 98 women with abnormal digital screening mammography. / Poplack SP, Tosteson TD, Kogel CA, Nagy HM. // AJR Am J Roentgenol. – 2007. – Vol. 189 – P. 616–623. https://doi.org/10.2214/AJR.07.2231; PMid:17715109

25. Digital breast tomosynthesis (DBT) : initial experience in a clinical setting. / Skaane P, Gullien R, Bjorndal H, [et al.] // Acta Radiol. – 2012. – Vol.53 – P.524–9. https://doi.org/10.1258/ar.2012.120062; PMid:22593120

26. Digital breast tomosynthesis is comparable to mammographic spot views for mass characterization. / Noroozian M, Hadjiiski L, Rahnama-Moghadam S, [et al.] // Radiology. – 2012. – Vol. 262 – P. 61–8. https://doi.org/10.1148/radiol.11101763; PMid:21998048 PMCid:PMC3244671

27. Effectiveness of population-based service screening with mammography for women ages 40 to 49 years: evaluation of the Swedish Mammography Screening in Young Women (SCRY) cohort. / Hellquist BN, Duffy SW, Abdsaleh S, [et al.] // Cancer. – 2011. – Vol. 117(4) – P. 714–22. https://doi.org/10.1002/cncr.25650; https://doi.org/10.1002/cncr.25999

28. False-negative breast screening assessment: what lessons can we learn? / Burrell H, Evans A, Wilson A, Pinder S.//Clin Radiol.–2001.– Vol.56–P.385–388. https://doi.org/10.1053/crad.2001.0662

29. Feng SS. Clinical Digital Breast Tomosynthesis System: Dosimetric Characterization. / Feng SS, Sechopoulos I. // Radiology. – 2012. – Vol. 263(1) – P. 35–42. https://doi.org/10.1148/radiol.11111789; PMid:22332070 PMCid:PMC3309800

30. Freer PE. Preoperative tomosynthesis-guided needle localization of mammographically and sonographically occult breast lesions. / Freer PE, Niell B, Rafferty EA // Radiology. – 2015. – Vol. 275(2) – P. 377–383. https://doi.org/10.1148/radiol.14140515; PMid:25575115

31. Helvie Mark A., M.D. Digital Mammography Imaging: Breast Tomosynthesis and Advanced Applications./ Mark A. Helvie, M.D. // Radiol Clin North Am. – 2010. – Vol. 48(5) – P. 917–929. https://doi.org/10.1016/j.rcl.2010.06.009; PMid:20868894 PMCid:PMC3118307

32. Histological correlation of microcalcifications in breast biopsy specimens. / Johnson JM, Dalton RR, Wester SM, [et al.] // Arch Surg. – 1999. – Vol. 134 – P. 712–716. https://doi.org/10.1001/archsurg.134.7.712; PMid:10401820

33. Imaging features and conspicuity of invasive lobular carcinomas on digital breast tomosynthesis./Chamming’s F, Kao E, Aldis A,[et al.]//Br J Radiol. – 2017.– Vol.90(1073). – doi: 10. 1259/ bjr.20170128. https: //doi. org/ 10.1259/ bjr.20170128.

34. Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study./ Ciatto S, Houssami N, Bernardi D, [et al.] // Lancet Oncol. – 2013. – Vol. 14 – P. 583–589. https://doi.org/10.1016/S1470-2045(13)70134-7

35. Knutzen AM. Likelihood of malignant disease for various categories of mammographically detected, nonpalpable breast lesions. / Knutzen AM, Gisvold JJ // Mayo Clin Proc. – 1993. – Vol. 68 – P. 454–460. https://doi.org/10.1016/S0025-6196(12)60194-3

36. Kopans DB. Digital Breast Tomosynthesis From Concept to Clinical Care/ Kopans DB//American Journal of Roentgenology. – 2014. – Vol.202 – P. 299-308. https://doi.org/10.2214/AJR.13.11520; PMid:24450669

37. Kopans DB. Just the facts: mammography saves lives with little if any radiation risk to the mature breast. / Kopans DB // Health Phys. – 2011. – Vol. 101 – P. 578–582. https://doi.org/10.1097/HP.0b013e3182254e93; PMid:21979544

38. Kopans DB. Screening for cancer: when is it valid? Lessons from the mammography experience./ Kopans DB, Monsees B, Feig SA// Radiology. – 2003. – Vol. 229 – P. 319–327. https://doi.org/10.1148/radiol.2292021272; PMid:14595137

39. Mean glandular dose estimation using MCNPX for a digital breast tomosynthesis system with tungsten/aluminum and tungsten/aluminum+silver x-ray anode-filter combinations. / Ma AKW, Darambara DG, Stewart A, [et al.] // Med Phys. – 2008. – Vol. 35(12) – P. 5278–5289. https://doi.org/10.1118/1.3002310; PMid:19175087

40. Morgan MP. Microcalcifications associated with breast cancer: an epiphenomenon or biologically significant feature of selected tumors? / Morgan MP, Cooke MM, McCarthy GM // J Mammary Gland Biol Neoplasia. – 2005. – Vol. 10 – P. 181–187. https://doi.org/10.1007/s10911-005-5400-6; PMid:16025224

41. Partyka L. Detection of mammographically occult architectural distortion on digital breast tomosynthesis screening: initial clinical experience. / Partyka L, Lourenco AP, Mainiero MB. // AJR Am J Roentgenol. – 2014. – Vol. 203(1) – P. 216–222. https://doi.org/10.2214/AJR.13.11047

42. Positive predictive value of specific mammographic findings according to reader and patient variables. / Venkatesan A, Chu P, Kerlikowske K, [et al.] // Radiology. – 2009. – Vol. 250(3) – P. 648–657. https://doi.org/10.1148/radiol.2503080541; PMid:19164116 PMCid:PMC2680167

43. Reassessment of breast cancers missed during routine screening mammography: a community-based study. / Yankaskas BC, Schell MJ, Bird RE, Desrochers DA. // AJR. – 2001. – Vol. 177 – P. 535–541. https://doi.org/10.2214/ajr.177.3.1770535; PMid:11517043

44. Review and management of breast lesions detected with breast tomosynthesis but not visible on mammography and ultrasonography. / Taskin F, Durum Y, Soyder A, Unsal A. // Acta Radiol. – 2017. – https://doi.org/10.1177/0284185117710681

45. Screening for breast cancer: an update for the U.S. Preventive Services Task Force. / Nelson HD, Tyne K, Naik A, [et al.] // Ann Intern Med. – 2009. – Vol. 151 – P. 727–737. https://doi.org/10.7326/0003-4819-151-10-200911170-00009; PMid:19920273 PMCid:PMC2972726

46. Screening interval breast cancers: mammographic features and prognostic factors. / Burrell HC, Sibbering DM, Wilson AR, [et al.] // Radiology. – 1996. – Vol. 199 – P. 811–817. https://doi.org/10.1148/radiology.199.3.8638010; PMid:8638010

47. Sechopoulos I. Glandular radiation dose in tomosynthesis of the breast using tungsten targets./ Sechopoulos I, D’Orsi CJ // J Appl Clin Med Phys. – 2008. – Vol. 9(4) – P. 2887. https://doi.org/10.1120/jacmp.v9i4.2887

48. Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination./ Warner E, Plewes DB, Hill KA, [et al.] // JAMA. – 2004. – Vol. 292 – P. 1317–1325. https://doi.org/10.1001/jama.292.11.1317; PMid:15367553

49. Suspicious Findings at Digital Breast Tomosynthesis Occult to Conventional Digital Mammography: Imaging Features and Pathology Findings. / Ray KM, Turner E, Sickles EA, Joe BN // Breast J. – 2015. – Vol. 21(5) – P. 538–42. https://doi.org/10.1111/tbj.12446; PMid:26148173

50. The randomized trials of breast cancer screening: what have we learned?/ Smith RA, Duffy SW, Gabe R, [et al.]. // Radiol Clin North Am. – 2004. – Vol. 42 – P. 793–806. https://doi.org/10.1016/j.rcl.2004.06.014; PMid:15337416

51. Tomosynthesis-detected Architectural Distortion: Management Algorithm with Radiologic-Pathologic Correlation. / Durand MA, Wang S, Hooley RJ, [et al.] // RadioGraphics. – 2016. – Vol. 36(2) – P. 311–321. https://doi.org/10.1148/rg.2016150093; PMid:26963448

52. Visualization of Breast Microcalcifications on Digital Breast Tomosynthesis and 2-Dimensional Digital Mammography Using Specimens. / Byun J, Lee JE, Cha ES, [et al.] // Breast Cancer: Basic and Clinical Research. – 2017. – Vol. 11. http://doi.org/10.1177/1178223417703388.