Medical audit of a rapid-throughput mammography screening practice: methodology and results of 27,114 examinations.

Sickles, Edward A.; Ominsky, S H; Sollitto, R A; Galvin, H B; Monticciolo, Debra L.

doi:10.1148/radiology.175.2.2326455

Cited by 158 publications

(57 citation statements)

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“…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).…”

mentioning

confidence: 87%

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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confidence: 87%

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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“…have lesions with a higher probability [13,14] of being malignant than do women for whom short-interval follow-up mammogra phy is recommended [1,2]. The greater stress associated with core biopsy could, therefore, be due to the patient's perception of this increasedrisk for carcinoma.Our data, however, show that the patient's percep tion of the probability that her lesion repre sentedcancer was not significantly related to the stressexperienced.Furthermore,when we controlledfor the patients'perceptionof the likelihood of malignancyby comparing stressamong those in both study groups who thought their lesions had a low probability of being malignant, the group undergoing core biopsy still experienced significantly greater stress than did the group undergoing rnam mographic surveillance.…”

Section: Womenundergoing Corebiopsygenerallymentioning

confidence: 99%

Short-interval follow-up mammography versus immediate core biopsy of benign breast lesions: assessment of patient stress.

Lindfors¹,

O'Connor²,

Acredolo³

et al. 1998

American Journal of Roentgenology

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OBJECTIVE. Thestress experienced bywomen undergoing surveillance mammographyfor benign lesions was compared with that experienced by women undergoing core biopsy of benign lesions. MATERIALSANDMETHODS.Aretrospective survey wasmailed towomen inwhomwere diagnosed breast abnormalities that were likely to be benign and that were stable at short-interval follow-up mammography (n = 174) or in whom a core biopsy of the breast was performed, with benign findings (n = 116). The survey included questions about stress related to the diagnostic experience as well as questions about who advised the women of the results of their breast imaging studies and about the information provided. RESULTS. Eighty eligible surveys werereceived fromthewomen whounderwent shortinterval follow-up mammography, and 58 surveys were received from the women who under went biopsies. The self-reported overall stress experienced by the women who underwent core biopsies was significantly greater (p < .001) than that reported by the group who were fol lowed up with mammography. The level of anxiety was not affected by the patient's percep tion of the probability that the lesion represented carcinoma. We found no significant differences in stress between women who discussed their mammogram results with a radiolo gistandwomenwho were notifiedby theirprimarycareprovider. CONCLUSION. Short-interval follow-up mammography continues tobeacceptable for theevaluationof lesionsthatareprobablybenign,evenwhen patientanxietyis considered.T he widespread use of screening mammography has resulted in the detectionof clinically occult and probably benign lesions in up to 11% of pa tients [ fl. Periodic mammographic surveil lance has been shown to be effective in the management of such abnormalities [1, 2]; however, the increasing availability of breast core biopsy has created controversy about the appropriate role of such biopsies in the evalua tion of these probably benign lesions. Series from the surgical literature have shown posi tive predictive values as low as 8% for core bi opsy [3,4]; authors of these studies have advocated the use of core biopsy instead of surveillance mammography.The suggestion has been made that needle biopsy should be used in lieu of periodic mammography to allay patient anxiety [5,6].Presumably, a definitive and timely diagnosis would entail less stress for the patient than would the uncertainty attending an extended period of surveillance.Becauseno previous empiric studies have focused on the relative stress experienced by women undergoing pe riodic mammographicsurveillanceas com pared with those undergoing immediate core biopsy, we conducted a retrospective, mailed survey to investigate this issue. Materials and MethodsA search of mammography reports from January I, 1994I, , until October 1, 1996, at two institutions yielded 174 women in whom had been diagnosed abnormalities that were probably benign (category lesions under the Breast Imaging Reporting andData System of the AmericanCollege of Radiology [7]) and that were stable at shor...

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“…18 The abnormalities were localized, and surgery was performed under general anesthesia. Ninety-five cancers were diagnosed: 65% were invasive, with the majority being ductal (35% were in situ cancers).…”

Section: Mammographically Guided Biopsies Of the Breastmentioning

confidence: 99%

The abnormal mammogram radiographic findings, diagnostic options, pathology, and stage of cancer diagnosis

McKenna¹

1994

Cancer

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An abnormal mammogram often will detect a mass, a cluster of calcifications, or both; these findings are not pathognomonic and require a tissue diagnosis to confirm the presence of invasive cancer, in situ cancer, or a nonmalignant process. Although mammography is very sensitive, its abnormalities may be nonspecific. Ultrasound may help to distinguish a cystic mass from a solid mass. The mammographic report should be concise and not vague and must provide the referring physician with clear information as to whether the test is normal, a biopsy must be performed on the abnormality, or the abnormality will be reviewed with a repeat X‐ray examination in 6‐month intervals until the nature of the abnormality is determined. A common error is to palpate a breast mass that is not visible on the mammogram (false negative) and assume that the mass is not cancerous. Reasonable interpretation of a mammographic abnormality must differentiate malignant disease from a variety of benign conditions and at the same time minimize the number of biopsies performed on a mammographic abnormality that proves to be benign. Asymptomatic breast cancer may be detected mammographically when screening mammography is used; five to seven cancers should be detected in each 1000 women when initially screened, and this incidence will decrease to 0.8–3.5 cancers per 1000 women screened, depending on their age. In recent reports, the detection of an in situ, or a Stage 0, breast cancer occurred in about 25% of the women screened. The earlier the stage, the better the prognosis and the more conservative the treatment options that may be offered to the patient. Every mammographic practice must be audited for quality control. Modern computer technology may make this effort less tedious and time‐consuming than it was in the past.

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Medical audit of a rapid-throughput mammography screening practice: methodology and results of 27,114 examinations.

Cited by 158 publications

References 0 publications

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

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

Short-interval follow-up mammography versus immediate core biopsy of benign breast lesions: assessment of patient stress.

The abnormal mammogram radiographic findings, diagnostic options, pathology, and stage of cancer diagnosis

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