Department of Radiology, Aalesund Hospital, Helse Sunnmøre HF, Aalesund, Norway.
Acad Radiol. 2011 Apr;18(4):454-60. doi: 10.1016/j.acra.2010.11.014. Epub 2011 Jan 8.
To increase radiologic knowledge, the distribution of mammographic features on prior screening mammograms of missed interval and screen-detected cancers was compared to the distribution on diagnostic mammograms of screen-detected cancers. The same variables were compared on mammograms of discordant and concordant screen-detected cancers.
The study was performed in Møre og Romsdal County, Norway, as a part of the quality assurance of the Norwegian Breast Cancer Screening Program. Women were screened using analog techniques and diagnosed from 2002 to 2008. Prior and diagnostic mammograms of 81 interval and 123 screen-detected breast cancers in women aged 50 to 71 years were retrospectively reviewed and classified as either missed or true by four experienced breast radiologists. Mammographic features were classified according to a modified Breast Imaging Reporting and Data System.
Thirty percent (24 of 81) of the interval cancers and 21% (26 of 123) of the screen-detected cancers were classified as missed. Calcifications, alone or in association with mass or asymmetry, tended to be more common on prior mammograms of missed cancers compared to diagnostic mammograms of screen-detected cancers (34% [17 of 50] vs 21% [26 of 123], P = .114), whereas an opposite trend was seen for mass (54% [27 of 50] vs 68% [84 of 123], P = .109). Similar results were seen when comparing discordant and concordant cancers.
Calcifications represent a challenge in the interpretation of screening mammograms. For educational purposes, the importance of reviewing both interval and screen-detected cancers is obvious. Knowledge gained from systematic reviews might reduce the number of missed cancers on mammographic screening. Performing reviews according to established guidelines would make it possible to compare results across screening programs.
为了增加放射学知识，我们比较了漏诊和筛查检出乳腺癌的既往筛查钼靶片上的乳腺特征分布与筛查检出乳腺癌的诊断钼靶片上的分布。我们还比较了不一致和一致的筛查检出乳腺癌钼靶片上的相同变量。
该研究在挪威摩尔达伦郡进行，是挪威乳腺癌筛查计划质量保证的一部分。女性使用模拟技术进行筛查，并于 2002 年至 2008 年进行诊断。回顾性分析了 50 至 71 岁女性的 81 例漏诊和 123 例筛查检出乳腺癌的既往和诊断钼靶片，并由 4 位有经验的乳腺放射科医生进行分类，判断为漏诊或真实。根据改良的乳腺影像报告和数据系统对乳腺特征进行分类。
30%（81 例中的 24 例）的间隔期癌症和 21%（123 例中的 26 例）的筛查检出癌症被归类为漏诊。与筛查检出乳腺癌的诊断钼靶片相比，漏诊乳腺癌的既往钼靶片中单纯或联合存在的钙化（34%[50 例中的 17 例]与 21%[123 例中的 26 例]，P =.114）更常见，而肿块则相反（54%[50 例中的 27 例]与 68%[123 例中的 84 例]，P =.109）。当比较不一致和一致的癌症时，也观察到了类似的结果。
钙化是解释筛查钼靶片的一个挑战。为了教育目的，回顾漏诊和筛查检出乳腺癌的重要性是显而易见的。从系统综述中获得的知识可能会减少乳腺筛查中的漏诊癌症数量。按照既定指南进行审查将使跨筛查计划比较结果成为可能。
