Yankaskas Bonnie C, Taplin Stephen H, Ichikawa Laura, Geller Berta M, Rosenberg Robert D, Carney Patricia A, Kerlikowske Karla, Ballard-Barbash Rachel, Cutter Gary R, Barlow William E
Department of Radiology, University of North Carolina at Chapel Hill, CB 7515, 106 Mason Farm Rd, Chapel Hill, NC 27599-7515, USA.
Radiology. 2005 Feb;234(2):363-73. doi: 10.1148/radiol.2342040048.
To evaluate whether there is an association between the number of months since previous mammography (MSPM) and performance measures (sensitivity, specificity, recall rate, cancer detection rate, and positive predictive value) in women who underwent U.S. community-based screening mammography.
Data from seven registries (Breast Cancer Surveillance Consortium) and mammographic data and cancer outcome in regard to 1 213 754 screening mammographic examinations performed in 680 641 women who were 40-89 years old for the years 1996-2000 were used in this study. These data are submitted annually in a standard format to a central statistical coordinating center that is subject to institutional review board approval, quality control, and confidentiality standards. Performance measures were calculated for first and subsequent screening mammography. For subsequent mammography, performance measures were calculated according to categories of MSPM (9-15, 16-20, 21-27, and >/=28 months). Receiver operating characteristic and multivariable logistic regression analyses were conducted to test the association between the number of MSPM and performance measures.
With increasing MSPM in each category from 9-15 to 28 months or more and for first mammographic examinations, respectively, there was increased sensitivity (70.9%, 75.7%, 85.4%, 82.5%, and 88.6%), decreased specificity (93.3%, 92.7%, 91.6%, 91.0%, and 85.9%), increased recall rate (7.0%, 7.6%, 8.8%, 9.4%, and 14.7%), and increased cancer detection rates (3.2, 3.5, 4.5, 4.6, and 6.1 per 1000 mammographic examinations). When the category of 9-15 MSPM was compared with that of 21-27 MSPM, there was a slight increase in positive predictive value from 4.6% to 5.1%. Confidence intervals were narrow and did not overlap. Age affected these associations for all performance measures except sensitivity.
Performance measures increased as MSPM increased, except for specificity, which decreased. Time between mammograms is an important factor to consider when audits are reviewed or screening performance measures are compared.
评估在美国社区进行乳腺钼靶筛查的女性中，自上次乳腺钼靶检查以来的月数（MSPM）与性能指标（敏感性、特异性、召回率、癌症检出率和阳性预测值）之间是否存在关联。
本研究使用了来自七个登记处（乳腺癌监测联盟）的数据，以及1996 - 2000年期间680641名年龄在40 - 89岁的女性所进行的1213754次乳腺钼靶筛查检查的钼靶数据和癌症结局。这些数据每年以标准格式提交给一个中央统计协调中心，该中心需经过机构审查委员会批准、质量控制和保密标准。计算首次及后续乳腺钼靶筛查的性能指标。对于后续乳腺钼靶检查，根据MSPM类别（9 - 15、16 - 20、21 - 27和≥28个月）计算性能指标。进行了受试者操作特征分析和多变量逻辑回归分析，以检验MSPM数量与性能指标之间的关联。
在每个类别中，随着MSPM从9 - 15个月增加到28个月或更长时间，以及对于首次乳腺钼靶检查，敏感性分别增加（70.9%、75.7%、85.4%、82.5%和88.6%），特异性降低（93.3%、92.7%、91.6%、91.0%和85.9%）,召回率增加（7.0%、7.6%、8.8%、9.4%和14.7%），癌症检出率增加（每1000次乳腺钼靶检查分别为3.2、3.5、4.5、4.6和6.1）。当将9 - 15 MSPM类别与21 - 27 MSPM类别进行比较时，阳性预测值从4.6%略有增加到5.1%。置信区间狭窄且不重叠。除敏感性外，年龄影响所有性能指标的这些关联。
除特异性降低外，性能指标随MSPM增加而增加。在审查审计或比较筛查性能指标时，钼靶检查之间的时间是一个需要考虑的重要因素。
