A private breast imaging practice: medical audit of 25,788 screening and 1,077 diagnostic examinations.

Robertson, Charles L.

doi:10.1148/radiology.187.1.8451440

Cited by 81 publications

(39 citation statements)

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“…In our study population a 6.1% prevalence of breast cancer was found, which is similar to Zonderland et al and Duijm et al, who reported a prevalence of 7% and 5%, respectively. 10,11,15 Our follow-up period is shorter than that used in these other studies. A 1-year follow-up was chosen to maximize the chance of detecting malignancies that were actually missed and to minimize the chance of finding newly developed cancers.…”

Section: Discussionmentioning

confidence: 91%

Diagnostic value of radiological breast imaging in a non-screening population

Flobbe¹,

Linden²,

Kessels³

et al. 2001

Int. J. Cancer

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The aim of this study was to assess the diagnostic performance of breast imaging in the diagnosis of breast cancer in a non-screening population. In a consecutive set of patients referred for mammography in one year, the results of palpation and radiological breast imaging were scored on a 5-point grading scale and linked to pathology as gold standard after a follow up period of one year. The diagnostic performance was studied by logistic regression analysis and ROC-curves. There were 1,944 breast examinations in 1,890 patients and 3,816 breasts. Pathology results reported 118 malignancies in 115 women. With a cut-off point between benign and uncertain benign a sensitivity of 89% and a specificity of 98% was found for radiological imaging. ROC-curves showed a significant increase in diagnostic performance when radiology was added to results of palpation and age (p ‫؍‬ 0.007). Radiological imaging tests have a large diagnostic value in the detection of breast cancer in addition to palpation and age. A sensitivity close to 100% could be reached. © 2001 Wiley-Liss, Inc. Key words: breast cancer; imaging; mammography; US; ROCBreast cancer is one of the leading causes of death among women in Western countries. The overall risk for the development of breast cancer over a lifetime is estimated to be 12.5% among American women 1,2 and about 10% among women in The Netherlands. 3 The diagnostic triad for evaluation of breast symptoms, the so-called "triple assessment system," involves clinical examination, radiological imaging and fine needle aspiration (FNA) cytology. If all investigations are carried out together a sensitivity of more than 99% can be obtained. 4,5 The value of mammography in screening for breast cancer is well studied, but the diagnostic value of non-screening breast imaging, using a combination of mammography and ultrasonography when indicated, is not well established. Many studies discussing the value of non-screening breast imaging describe populations diagnosed with breast cancer. 5-9 Very few studies describe breast imaging in a clinical population, 10,11 and these studies did not examine the role of palpation and age in the diagnostic process.The aim of this prospective study was to assess the diagnostic performance of breast imaging in the diagnosis of breast cancer among a non-screening population. MATERIAL AND METHODSAll consecutive patients referred for mammography to the Radiology Department of the University Hospital Maastricht in 1994 were included in the study. Investigations were performed in fixed order. Palpation was followed by standard craniocaudal and mediolateral oblique mammograms. When indicated according to the opinion of the radiologist, patients subsequently underwent ultrasonography. For the purpose of this study, the combination of mammography and ultrasonography will be called "radiological breast imaging."Imaging examinations obtained as follow-up to breast-saving surgery or amputation were excluded. For patients with multiple examinations during the study period, all exami...

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Section: Discussionmentioning

confidence: 91%

Diagnostic value of radiological breast imaging in a non-screening population

Flobbe¹,

Linden²,

Kessels³

et al. 2001

Int. J. Cancer

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“…Comparison with other series is difficult as the positive predictive value of breast imaging depends on several other factors as well (Kopans, 1992). However, the integral use of mammography and ultrasonography will have helped us to obtain a positive predictive value that was substantially higher than in diagnostic studies in which ultrasound was not used (Wolfe et al, 1987;Robertson, 1993;Sienko et al, 1993).…”

Section: Discussionmentioning

confidence: 99%

“…The sensitivity and specificity of mammography in the detection of breast cancer have been reported in several screening studies (Tabar et al, 1984;Baines et al, 1986;Bird, 1989;Sickles et al, 1990;Robertson, 1993) and diagnostic (consultative) studies (Wolfe et al, 1987;Hansell et al, 1988;Reintgen et al, 1993;Robertson, 1993;Sienko et al, 1993). However, in diagnostic studies, these parameters have frequently been determined retrospectively in pathologically proven breast cancers (Hansell et al, 1988;Reintgen et al, 1993).…”

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confidence: 88%

“…However, in diagnostic studies, these parameters have frequently been determined retrospectively in pathologically proven breast cancers (Hansell et al, 1988;Reintgen et al, 1993). Moreover, the follow-up period has usually been 12 months or less (Wolfe et al, 1987;Robertson, 1993), and the proportion of patients lost to follow-up has not been well defined in many of the studies (Baines et al, 1986;Bird, 1989;Sienko et al, 1993). For these reasons, the actual sensitivity and specificity of breast imaging in the detection of breast cancer will be lower than reported.…”

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confidence: 99%

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Sensitivity, specificity and predictive values of breast imaging in the detection of cancer

Duijm

Guit²,

Zaat³

et al. 1997

Br J Cancer

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Summary In an observational follow-up study we determined whether the combined use of mammography and breast ultrasonography is an appropriate diagnostic tool to select patients with symptomatic breast disease who need additional pathological evaluation. Mammography and ultrasound were used as complementary diagnostic modalities in 3014 consecutively referred and mainly symptomatic patients. Sensitivity, specificity, predictive values and likelihood ratios were calculated according to standard procedures. Virtually complete follow-up was obtained by correlating the radiological diagnosis with clinical records, final pathological findings, records from the Cancer Register and data from questionnaires sent to the general practitioners of all the referred patients. After an average follow-up period of 30 months, the sensitivity for breast cancer detection was 92.0% and the specificity 97.7%. A positive predictive value of 68.0%, a negative predictive value of 99.6%, a positive likelihood ratio of 40 and a negative likelihood ratio of 0.08 were found. The mean diagnostic delay as a result of false negative examinations was 9 months (range 0-20 months). We conclude that breast imaging in routine daily practice, consisting of the integral use of mammography and ultrasonography, is an appropriate tool in the detection of cancer and should be included in the work-up of symptomatic breast disease.Keywords: breast neoplasm; mammography; ultrasonography; sensitivity; specificity In many Western countries breast cancer is the most common cause of death in women aged 35-55. The sensitivity and specificity of mammography in the detection of breast cancer have been reported in several screening studies (Tabar et al, 1984;Baines et al, 1986;Bird, 1989;Sickles et al, 1990;Robertson, 1993) and diagnostic (consultative) studies (Wolfe et al, 1987;Hansell et al, 1988;Reintgen et al, 1993;Robertson, 1993;Sienko et al, 1993). However, in diagnostic studies, these parameters have frequently been determined retrospectively in pathologically proven breast cancers (Hansell et al, 1988;Reintgen et al, 1993). Moreover, the follow-up period has usually been 12 months or less (Wolfe et al, 1987;Robertson, 1993), and the proportion of patients lost to follow-up has not been well defined in many of the studies (Baines et al, 1986;Bird, 1989;Sienko et al, 1993). For these reasons, the actual sensitivity and specificity of breast imaging in the detection of breast cancer will be lower than reported.The value of ultrasound examination of the breast as an adjunct to mammography, in the work-up of symptomatic breast disease is well established (Fleischer et al, 1983;Bassett et al, 1987;Warwick et al, 1988;Jackson, 1995). No prospective series with well-specified follow-up have been published in which both modalities are used as an integrated approach to determine the sensitivity and specificity in symptomatic patients.To overcome the restrictions mentioned, we performed a prospective study with extensive follow-up of over 3000 consecutive

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“…First, it measures the mammographer's success in finding cancers, especially impalpable cancers, as compared with emerging national trends and goals [2][3][4]8]. Regular review of individual and group audit data serves as a teaching tool, providing comparisons of performance and improving future outcomes [3].…”

Section: The Mammography Audit-its Valuementioning

confidence: 99%