CAR乳腺影像与介入实践指南:乳腺X线与数字乳腺断层摄影
加拿大放射科医师协会(CAR)乳腺影像工作组制定本指南第一部分,聚焦乳腺X线与数字乳腺断层摄影(DBT),在2016版基础上更新筛查与诊断的循证推荐。内容涵盖临床适应证、设备与技术标准、辐射剂量、BI-RADS®报告、人员资质与性能基准,并强调DBT在乳腺癌检出中的核心作用及人工智能等新技术的整合。
要点
- 乳腺X线与DBT是乳腺癌检出的核心手段,本指南为其筛查与诊断提供更新推荐。
- 报告应采用BI-RADS®规范,并关注设备技术标准与辐射剂量控制。
- 指南为最低期望与最佳实践,实际应用可因患者因素与资源条件存在合理差异。
核心结论
- 指南强调乳腺X线与DBT在乳腺癌检出中的核心作用,并支持整合人工智能等新兴技术以提升诊断准确性与效率。
- 本指南应与CAR乳腺实践指南其余4个部分及CAR乳腺疾病影像转诊指南配合使用。
研究设计与样本
- 由加拿大放射科医师协会(CAR)乳腺影像工作组制定,属于实践指南,基于证据更新2016年版整合指南。
- 指南涵盖临床适应证、设备与技术标准、辐射剂量、BI-RADS®报告、人员资质与性能基准等关键领域。
诊断标准与关键数值
- 报告采用BI-RADS®规范,并列出性能基准,但原文摘要未给出具体敏感度、特异度、AUC或阈值数值。
- 指南提出设备与技术标准、辐射剂量考量及人员资质要求作为实践的最低期望。
临床应用与阅片要点
- 日常乳腺X线与DBT阅片及报告应按BI-RADS®规范书写,并参照指南的设备技术标准与性能基准。
- 应用新兴技术(如人工智能)辅助诊断时,应结合指南推荐与本地资源条件综合决策。
局限性
- 原文摘要未报告研究样本量、中心数与具体性能数值。
- 指南承认实践可因患者因素与可用资源不同而存在合理差异,临床决策最终由主管放射科医师负责。
以上解读依据论文摘要(全文未开放获取或许可不允许翻译转载)。
英文原文(摘要)· 点击展开
This guideline presents Part I of the Canadian Association of Radiologists (CAR) Practice Guidelines on Breast Imaging and Intervention and focuses on mammography and digital breast tomosynthesis (DBT). Developed by the CAR Breast Imaging Working Group, this guideline provides updated, evidence-based recommendations for screening and diagnostic mammography, reflecting advances in digital imaging, tomosynthesis, artificial intelligence, and quality assurance since the previous consolidated guidelines published in 2016. Key areas addressed include clinical indications, equipment and technical standards, radiation dose considerations, reporting using BI-RADS®, personnel qualifications, and performance benchmarks. This guideline emphasizes the central role of mammography and DBT in breast cancer detection while supporting the integration of emerging technologies to improve diagnostic accuracy and efficiency. It is intended to be used in conjunction with the other 4 components of the CAR Breast Practice Guidelines on Breast Imaging and Intervention and alongside the CAR Breast Disease Imaging Referral Guidelines. While outlining best practices and minimum expectations, this guideline acknowledges that practice variation may be appropriate based on patient factors and available resources, with ultimate responsibility for clinical decision-making resting with the supervising radiologist.
引用
- Fleming R, Crivellaro PS, Fienberg S, et al. CAR Practice Guidelines on Breast Imaging and Interventions: Mammography and Digital Breast Tomosynthesis. Can Assoc Radiol J. 2026. PMID: 42198822. doi:10.1177/08465371261451252
供执业医师工作参考,不替代临床判断;数值与分级以指南原文为准。