背景数字乳房层析成像（DBT）后跟目标超声常用于评估有局部乳房不适的女性。然而，除目标超声之外添加DBT的附加价值尚不明确。省略DBT可能具有成本效益和提高患者舒适度的优点，但可能会错过潜在的乳腺癌。目的评估以目标超声为唯一成像协议在对有局部症状的女性进行诊断工作时是否可行，并评估DBT在这种逆向情况下的辅助价值。方法与材料本前瞻性研究招募了2017年9月至2019年6月间在荷兰的三家医院中连续收治的年龄在30岁及以上、乳房局部有病理性表现的女性。所有参与者在首次接受目标超声评估后，如有必要，进行活检，然后进行DBT检查。主要结局是由DBT检测到的在超声为阴性时的乳腺癌发现的频率。次要结局是由DBT检测到的在乳房其他位置的癌症发现的频率以及目标超声加DBT的综合敏感性。参考标准是1年的随访或组织病理学检查。结果共招募了1961名女性（平均年龄±SD，47岁±12岁）。在仅选择目标超声评估时，1587名参与者（81%）的检测结果为正常或良性结果，1759名参与者（90%）有明确的准确诊断结果。总共，在初始诊断过程中检测到了204例乳腺癌。使用超声评估的恶性发现率为10%（1961名参与者中的192例）（超声敏感性为98.5% [95% CI: 96, 100]; 超声特异性为90.8% [95% CI: 89, 92]）。DBT在检测到位于检查部位的三个未被观察到的恶性病灶以及在无症状性癌症患者中检测到0.41%（8位患者中的1位）的偶然恶性发现方面具有优势。结论与综合使用超声和DBT相比，目标超声作为唯一的乳房成像方式在评估局部乳房不适方面具有高准确性。DBT检测到在乳腺其他部位的癌症的发现率，与筛查乳房X线摄影的癌症检测率相当。本文提供了补充材料。本期编辑记者Newell还发表了一篇社论。

Background Digital breast tomosynthesis (DBT) followed by targeted US is commonly performed to evaluate women with localized breast complaints. However, the added value of DBT in addition to targeted US is unknown. Omitting DBT may be cost-effective and improve patient comfort but may miss potential breast cancer. Purpose To assess whether an imaging protocol consisting of targeted US alone may be feasible for the diagnostic work-up of women with localized symptoms and to assess the supplemental value of DBT in this reversed setting. Materials and Methods This prospective study enrolled consecutive women aged 30 years or older with focal breast complaints in three hospitals in the Netherlands between September 2017 and June 2019. In all participants, first, targeted US was evaluated, and if needed, biopsy was performed, followed by DBT. The primary outcome was the frequency of breast cancer detected with DBT when US was negative. Secondary outcomes were frequency of cancer detected with DBT elsewhere in the breast and combined overall sensitivity of US plus DBT. The reference standard was 1 year follow-up or histopathologic examination. Results There were 1961 women (mean age ± SD, 47 years ± 12) enrolled. Based on initial US alone, 1587 participants (81%) had normal or benign findings and 1759 (90%) had a definitive accurate diagnosis. In total, 204 breast cancers were detected during initial work-up. The frequency of malignancy was 10% (192 of 1961 participants) with US (US sensitivity, 98.5% [95% CI: 96, 100]; US specificity, 90.8% [95% CI: 89, 92]). DBT depicted three unobserved malignant lesions at the complaint site and 0.41% (eight of 1961 participants) of incidental malignant findings in participants without symptomatic cancer. Conclusion Compared with combined US and DBT, US was accurate as a stand-alone breast imaging modality in the assessment of focal breast complaints. The rate of cancer detection of cancers elsewhere in the breast with DBT is comparable to cancer detection rate of screening mammography. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Newell in this issue.