Departments of Radiology and Oncology, Aalesund Hospital, Helse Møre og Romsdal HF, Aalesund, Norway.
Radiology. 2012 Aug;264(2):378-86. doi: 10.1148/radiol.12112074. Epub 2012 Jun 14.
To compare the percentages and mammographic features of cancers missed at full-field digital mammography (FFDM) and screen-film mammography (SFM) in women who participated in the Norwegian Breast Cancer Screening Program in 2002-2008.
Social Science Data Services approval was obtained; the requirement for informed consent was waived. Cases were all the interval and screening-detected cancers from 35 127 FFDM and 52 444 SFM examinations in two Norwegian counties. Prior and diagnostic FFDM examinations of 49 interval and 86 screening-detected breast cancers were reviewed by four breast radiologists and compared with a review of SFM examinations of 81 interval and 123 screening-detected cancers. Cancers were classified as missed or true, mammographic features were described, percentages were compared by using the χ(2) or Fisher exact test, and 95% confidence intervals (CIs) were calculated.
The percentages of interval and screening-detected cancers missed at FFDM and SFM did not differ significantly. (interval cancers missed: 33% [16 of 49] at FFDM vs 30% [24 of 81] at SFM [P = .868]; screening-detected cancers missed: 20% [17 of 86] at FFDM vs 21% [26 of 123] at SFM [P = .946]). Asymmetry was present in 27% (95% CI: 13.3%, 45.5%) of prior mammograms of cancers missed at FFDM and 10% (95% CI: 3.3%, 21.8%) of those missed at SFM (P = .070). Calcifications were observed in 18% (95% CI: 7.0%, 35.5%) of the cancers missed at FFDM and 34% (95% CI: 21.2%, 48.8%) of those missed at SFM (P = .185). Average mammographic tumor size of missed cancers manifesting as masses was 10.4 mm at FFDM and 13.6 mm at SFM (P = .036).
The use of FFDM has not reduced the challenge of missed cancers. Cancers missed at FFDM tend to have different mammographic features than those missed at SFM.
比较 2002-2008 年参加挪威乳腺癌筛查计划的女性中全数字化乳腺摄影（FFDM）和屏片乳腺摄影（SFM）漏诊的癌症百分比和乳腺摄影特征。
获得了社会科学数据服务的批准；放弃了知情同意的要求。病例均为两个挪威县的 35 127 例 FFDM 和 52 444 例 SFM 筛查间隔和筛查检出的癌症。对 49 例间隔和 86 例筛查检出乳腺癌的前后 FFDM 检查以及 81 例间隔和 123 例筛查检出乳腺癌的 SFM 检查进行了四位乳腺放射科医生的回顾，并进行了比较。将癌症分为漏诊或真阳性，描述乳腺摄影特征，通过使用 χ(2)或 Fisher 确切检验比较百分比，并计算 95%置信区间（CI）。
FFDM 和 SFM 漏诊的间隔和筛查检出的癌症百分比无显著差异。（FFDM 漏诊的间隔癌：33%[49 例中的 16 例] vs SFM 漏诊的间隔癌：30%[81 例中的 24 例] [P =.868]；FFDM 漏诊的筛查检出癌：20%[86 例中的 17 例] vs SFM 漏诊的筛查检出癌：21%[123 例中的 26 例] [P =.946]）。FFDM 漏诊癌症的既往乳腺 X 线检查中存在不对称性的占 27%（95%CI：13.3%，45.5%），SFM 漏诊癌症的占 10%（95%CI：3.3%，21.8%）（P =.070）。FFDM 漏诊的癌症中观察到钙化的占 18%（95%CI：7.0%，35.5%），SFM 漏诊的癌症中观察到钙化的占 34%（95%CI：21.2%，48.8%）（P =.185）。FFDM 表现为肿块的漏诊癌症的平均乳腺肿瘤大小为 10.4mm，SFM 为 13.6mm（P =.036）。
使用 FFDM 并未降低漏诊癌症的挑战。FFDM 漏诊的癌症往往具有与 SFM 漏诊的癌症不同的乳腺摄影特征。
