Yankaskas B C, Cleveland R J, Schell M J, Kozar R
Department of Radiology, CB 7515, Mason Farm Rd., University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7515, USA.
AJR Am J Roentgenol. 2001 Sep;177(3):543-9. doi: 10.2214/ajr.177.3.1770543.
The performance of screening mammography is measured mainly by its sensitivity, positive predictive value, and cancer detection rate. Recall rates are also suggested as a surrogate measure. The main objective of this study was to measure the effect on sensitivity and positive predictive value as recall rates increase in the community practice of mammography.
Mammography and pathology data are linked in the Carolina Mammography Registry, a population-based registry of screening mammography. Our mammography database is created from prospectively collected data from mammography facilities; the data include information on the woman and the imaging studies. Our pathology database is created from prospectively collected breast pathology data received from pathology sites and the Central Cancer Registry. Women in the registry who were 40 years old and older and who underwent screening mammography between January 1994 and June 1998 were included. "Recall rate" was defined as the percentage of screening studies for which further workup was recommended by the radiologist.
The study included 215,665 screening mammograms. The mean age of the women was 56 years. The recall rates of the average practice ranged from 1.9% to 13.4%. Sensitivity rose from a mean of 65% in the lowest recall rates to 80.2% at the highest level of recall rates. The positive predictive value of screening decreased from 7.2% in the lowest level of recall to 3.3% in the highest. As recall rates increased, sensitivity increased very little beyond a recall rate of 4.8%, and positive predictive value began decreasing significantly at a recall rate of 5.9%.
Practices with recall rates between 4.9% and 5.5% achieve the best trade-off of sensitivity and positive predictive value.
乳腺钼靶筛查的性能主要通过其灵敏度、阳性预测值和癌症检出率来衡量。召回率也被建议作为一项替代指标。本研究的主要目的是在社区乳腺钼靶检查实践中，衡量随着召回率的增加对灵敏度和阳性预测值的影响。
乳腺钼靶检查和病理数据在卡罗莱纳乳腺钼靶登记处相链接，该登记处是一个基于人群的乳腺钼靶筛查登记处。我们的乳腺钼靶数据库由从乳腺钼靶检查机构前瞻性收集的数据创建；数据包括女性及影像检查的信息。我们的病理数据库由从病理科室和中央癌症登记处前瞻性收集的乳腺病理数据创建。登记处中年龄在40岁及以上且在1994年1月至1998年6月期间接受乳腺钼靶筛查的女性被纳入研究。“召回率”定义为放射科医生建议进一步检查的筛查检查的百分比。
该研究包括215,665例乳腺钼靶筛查。女性的平均年龄为56岁。平均检查的召回率在1.9%至13.4%之间。灵敏度从召回率最低时的平均65%升至召回率最高时的80.2%。筛查的阳性预测值从召回率最低时的7.2%降至最高时的3.3%。随着召回率的增加，当召回率超过4.8%时，灵敏度增加很少，而当召回率达到5.9%时，阳性预测值开始显著下降。
召回率在4.9%至5.5%之间的检查在灵敏度和阳性预测值之间实现了最佳平衡。
