Institute of Clinical Epidemiology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160 (Haus 50), 23538 Luebeck, Germany.
Eur Radiol. 2012 May;22(5):1014-22. doi: 10.1007/s00330-011-2334-9. Epub 2011 Nov 18.
To address the benefits of double and arbitration reading regarding tumour detection rates, percentage of in situ tumours, and number (of patients) needed to send for expert reading (number needed to treat; NNT) for one additional tumour finding.
QuaMaDi is a quality assured breast cancer diagnosis programme; with two-view mammography (craniocaudal, mediolateral oblique) and, in case of breast density ACR 3 or 4, routine ultrasound imaging; and with independent double reading of all images. A consecutive sample of symptomatic women, i.e. women at risk for breast cancer, women aged 70 and above, and/or women with preceding BI-RADS III findings, was analysed.
28,558 mammograms were performed (mean age of women: 57.3 [standard deviation: 12.3] years). Discordant findings were present in 3,837 double readings and were sent for arbitration reading. After histopathological assessment, 52 carcinomas were found (thereof 32% in situ). These carcinomas accounted for 1.8 tumours per 1,000 examinations in the total cohort and increased the tumour detection rate up to 16.4/1,000. The NNT in discordant cases was 74.
Double and arbitration reading appears to be a useful tool to ensure the quality of early detection of breast lesions in symptomatic women during indication-based, standardised mammography.
• Quality assured breast cancer diagnosis is feasible outside organised screening structures. • Double and arbitration reading is beneficial for populations ineligible for screening. • Double and arbitration reading increases the tumour detection rate. • Double and arbitration reading increases the percentage of in situ cancers.
探讨双读和仲裁读在肿瘤检出率、原位肿瘤百分比以及为发现 1 例额外肿瘤所需发送专家读片的患者数量（治疗所需数量；NNT）方面的获益。
QuaMaDi 是一个具有质量保证的乳腺癌诊断项目；采用双视图乳腺 X 线摄影（头尾位、内外斜位），并且在乳腺密度为 ACR 3 或 4 时常规进行超声检查；所有图像均进行独立的双读。分析了一个连续的症状性女性样本，即乳腺癌高危女性、年龄 70 岁及以上的女性和/或有先前 BI-RADS III 发现的女性。
共进行了 28558 次乳腺 X 线摄影（女性平均年龄：57.3 [标准差：12.3] 岁）。在 3837 次双读中发现了不一致的结果，并发送进行仲裁读。经过组织病理学评估，发现 52 例癌（其中 32%为原位癌）。这些癌在总队列中每 1000 例检查中占 1.8 个肿瘤，使肿瘤检出率增加至 16.4/1000。在不一致的病例中，NNT 为 74。
双读和仲裁读似乎是一种有用的工具，可以确保在基于指征的标准化乳腺 X 线摄影中，对有症状的女性进行早期乳腺病变检测的质量。
• 在有组织的筛查结构之外，进行具有质量保证的乳腺癌诊断是可行的。• 双读和仲裁读对不符合筛查条件的人群有益。• 双读和仲裁读增加了肿瘤检出率。• 双读和仲裁读增加了原位癌的百分比。
