Registre du Cancer de l'Isère, Centre Hospitalier Universitaire de Grenoble, BP 217, Pavillon E, 38043 Grenoble Cedex 9, France.
Breast Cancer Res Treat. 2011 May;127(1):221-8. doi: 10.1007/s10549-010-1118-2. Epub 2010 Aug 31.
The objective of this study is to determine whether the likelihood of returning for routine breast cancer screening differed for false-positive cases depending on the diagnostic work-up. Using the original data from a French population-based breast cancer screening program, we compared the attendance rates at the subsequent round of screening for 16,946 and 1,127 participants who received negative (i.e., American College of Radiology, ACR, categories 1-2) and false-positive mammograms, respectively. False-positive mammograms were categorized ACR 0 (i.e., warranting additional imaging evaluation), 3 (i.e., warranting clinical and imaging follow-up), and 4-5 (i.e., warranting biopsy). We estimated the odds ratios of attendance at subsequent screening round using logistic regression, adjusting for age and history of previous mammography. The attendance rates at the subsequent screening round were 80.6% for women who received negative mammograms versus 69.6, 74.3, and 70.1% for women who received false-positive mammograms warranting additional imaging evaluation, clinical and imaging follow-up, or biopsy, respectively. In comparison to women who received negative mammograms, the corresponding adjusted odds ratios of returning for routine screening were 0.6 [95% confidence interval (CI) 0.4-0.8], 0.8 (95% CI 0.6-0.9), and 0.6 (95% CI 0.4-0.8). No significant differences were found in odds ratios of attendance across ACR categories among women who received false-positive mammograms. Similar figures were observed for attending at least one of the two subsequent screening rounds. In conclusion, in comparison to women with normal or benign findings on index mammograms, false-positive cases warranting additional imaging evaluation, clinical and imaging follow-up, or biopsy had uniformly decreased odds of attending subsequent routine screening rounds.
本研究旨在确定因假阳性结果而接受后续诊断检查的乳腺癌筛查患者与因阴性结果而接受后续筛查的患者相比，其返回进行常规乳腺癌筛查的可能性是否存在差异。我们使用法国基于人群的乳腺癌筛查项目的原始数据，比较了分别接受阴性（即美国放射学院[ACR] 1-2 类）和假阳性乳腺 X 线摄影的 16946 名和 1127 名参与者在随后的筛查轮次中的就诊率。假阳性乳腺 X 线摄影被分为 ACR 0 类（即需要额外影像学评估）、3 类（即需要临床和影像学随访）和 4-5 类（即需要活检）。我们使用逻辑回归估计了随后筛查轮次就诊的比值比，调整了年龄和既往乳腺 X 线摄影史的影响。接受阴性乳腺 X 线摄影的女性随后筛查轮次的就诊率为 80.6%，而接受需要额外影像学评估、临床和影像学随访或活检的假阳性乳腺 X 线摄影的女性的就诊率分别为 69.6%、74.3%和 70.1%。与接受阴性乳腺 X 线摄影的女性相比，接受额外影像学评估、临床和影像学随访或活检的女性返回常规筛查的相应调整比值比分别为 0.6（95%置信区间[CI] 0.4-0.8）、0.8（95% CI 0.6-0.9）和 0.6（95% CI 0.4-0.8）。在接受假阳性乳腺 X 线摄影的女性中，ACR 类别之间的就诊率比值比没有显著差异。在至少参加了两次后续筛查轮次中的一次的女性中也观察到了类似的结果。总之，与索引乳腺 X 线摄影结果正常或良性的女性相比，需要额外影像学评估、临床和影像学随访或活检的假阳性病例后续常规筛查轮次的就诊可能性普遍降低。
