Department of Radiology, Catharina Hospital, Michelangelolaan 2, PO Box 1350, 5602 ZA, Eindhoven, The Netherlands.
Radiology. 2011 Aug;260(2):357-63. doi: 10.1148/radiol.11102117. Epub 2011 Apr 7.
To determine the incidence of bilateral breast cancer at biennial screening mammography and to assess the sensitivity of screening in the detection of bilateral breast cancer.
All women gave written informed consent, and the requirement to obtain review board approval was waived. The authors included all 302,196 screening mammograms obtained in 80,466 women aged 50-75 years in a southern breast screening region of the Netherlands between May 1998 and July 2008. During 2-year follow-up, the authors collected clinical data, breast imaging reports, biopsy results, and breast surgery reports from all patients with screening-detected and interval cancers. Two screening radiologists reviewed the screening and clinical mammograms of all bilateral screening-detected and interval cancers for mammographic abnormalities. The radiologists were initially blinded to each other's referral opinion, and discrepant assessments were followed by consensus reading.
Of all women with screening-detected cancer (n = 1555) or interval cancer (n = 585), 52 (2.4%) had bilateral breast cancer. The sensitivity of screening mammography in the detection of bilateral breast cancer was 19% (10 of 52 women; 95% confidence interval: 8.5%, 29.9%). At blinded review, 18 of the 53 tumors not detected at screening (34%) were considered to be missed, 11 (21%) showed nonspecific minimal signs, and 24 (45%) had been mammographically occult at screening. Five women referred for further analysis experienced a 6-17-month delay in the diagnosis of the second breast cancer; in four of those women, the delay resulted from an incorrect Breast Imaging Reporting and Data System classification at clinical mammography.
The sensitivity of screening mammography in the detection of bilateral breast cancer is disappointingly low. Both screening radiologists and clinical radiologists should pay vigorous attention to the contralateral breast to detect bilateral malignancies without diagnostic delay.
确定在两年一次的筛查性乳房 X 光摄影中双侧乳腺癌的发生率，并评估筛查在检测双侧乳腺癌中的敏感性。
所有女性均书面签署知情同意书，且无需获得审查委员会的批准。作者纳入了 1998 年 5 月至 2008 年 7 月在荷兰南部乳房筛查区域进行的 80466 名 50-75 岁女性的 302196 例筛查性乳房 X 光摄影。在 2 年的随访期间，作者从所有筛查性发现癌和间隔性癌患者中收集临床数据、乳房影像学报告、活检结果和乳房手术报告。两位筛查放射科医生对所有筛查性发现和间隔性癌症的双侧筛查性发现和间隔性癌症的筛查和临床乳房 X 光片进行了乳腺影像学异常的回顾。放射科医生最初对彼此的转诊意见保持盲态，不一致的评估结果则通过共识阅读来确定。
在所有筛查性发现癌（n=1555 例）或间隔性癌（n=585 例）的女性中，有 52 例（2.4%）患有双侧乳腺癌。筛查性乳房 X 光摄影在检测双侧乳腺癌中的敏感性为 19%（52 例女性中有 10 例；95%置信区间：8.5%，29.9%）。在盲法审查中，53 例未在筛查中发现的肿瘤中有 18 例（34%）被认为是漏诊，11 例（21%）显示出非特异性的微小征象，24 例（45%）在筛查时已在乳房 X 光摄影中隐匿。有 5 例女性因进一步分析而被转诊，她们的第二侧乳腺癌诊断延迟了 6-17 个月；在这 5 例女性中，有 4 例的延迟是由于临床乳房 X 光摄影中不正确的乳腺影像报告和数据系统分类导致的。
筛查性乳房 X 光摄影在检测双侧乳腺癌中的敏感性令人失望。筛查放射科医生和临床放射科医生都应密切关注对侧乳房，以在不导致诊断延迟的情况下发现双侧恶性肿瘤。
