Breastscreen WA, Perth, Australia.
Clin Radiol. 2011 Oct;66(10):928-39. doi: 10.1016/j.crad.2011.03.017. Epub 2011 Jun 30.
To review factors resulting in a false-negative outcome or delayed cancer diagnosis in women recalled for further evaluation, including ultrasound, after an abnormal screening mammogram.
Of 646,692 screening mammograms performed between 1 January 1995 and 31 December 2004, 34,533 women were recalled for further assessment. Nine hundred and sixty-four interval cancers were reported in this period. Forty-six of these women had been recalled for further assessment, which specifically included ultrasound evaluation in the preceding 24 months, and therefore, met the inclusion criteria for this study. Screening mammograms, further mammographic views, ultrasound scans, clinical findings, and histopathology results were retrospectively reviewed by two consultant breast radiologists.
The interval cancer developed in the contralateral breast (n=9), ipsilateral breast, but different site (n=6), and ipsilateral breast at the same site (n=31) as the abnormality for which they had recently been recalled. In the latter group, 10 were retrospectively classified as a false-negative outcome, nine had a delay in obtaining a biopsy, and 12 had a delay due to a non-diagnostic initial biopsy. Various factors relating to these outcomes are discussed.
Out of 34,533 women who attended for an assessment visit and the 46 women who subsequently developed an interval breast cancer, 15 were true interval cancers, 10 had a false-negative assessment outcome, and 21 had a delay to cancer diagnosis on the basis of a number of factors. When there is discrepancy between the imaging and histopathology results, a repeat biopsy rather than early follow-up would have avoided a delay in some cases. A normal ultrasound examination should not deter the radiologist from proceeding to stereotactic biopsy, if the index mammographic lesion is suspicious of malignancy.
回顾导致女性在异常筛查乳房 X 光片后接受进一步评估（包括超声检查）时出现假阴性结果或延迟癌症诊断的因素。
在 1995 年 1 月 1 日至 2004 年 12 月 31 日期间进行的 646692 次筛查乳房 X 光片中，有 34533 名女性被召回进行进一步评估。在此期间报告了 964 例间隔期癌症。其中 46 名女性在过去 24 个月内被召回进行进一步评估，包括超声检查，因此符合本研究的纳入标准。由两名顾问乳腺放射科医生回顾性审查筛查乳房 X 光片、进一步的乳房 X 光片、超声扫描、临床发现和组织病理学结果。
间隔期癌症发生在对侧乳房（n=9）、同侧乳房但不同部位（n=6）和同侧乳房与异常部位（n=31）。在后一组中，有 10 例被回顾性地归类为假阴性结果，9 例活检延迟，12 例因初始活检无诊断而延迟。讨论了与这些结果相关的各种因素。
在 34533 名接受评估就诊的女性和随后发展为间隔期乳腺癌的 46 名女性中，15 例为真正的间隔期癌症，10 例评估结果为假阴性，21 例因多种因素导致癌症诊断延迟。当影像学和组织病理学结果不一致时，重复活检而不是早期随访可以避免一些情况下的延迟。如果索引乳房 X 光片病变怀疑为恶性肿瘤，正常的超声检查不应阻止放射科医生进行立体定向活检。
