Unità di Radiologia, IRCCS Policlinico San Donato, Piazza E. Malan 2, San Donato Milanese (Mi) 20097, Italy(2).
Servizio di Radiologia, Azienda Ospedaliera Circolo di Melegnano, Via Pandina 1, Vizzolo Predabissi (Mi) 20070, Italy(3).
Eur J Radiol. 2014 Feb;83(2):e84-91. doi: 10.1016/j.ejrad.2013.11.025. Epub 2013 Dec 6.
To evaluate the performance of the first years since the beginning of a mammographic population-based screening program.
Women aged 49-69 were invited biennially for two-view film-screen mammography and double reading without arbitration was performed. Interval cancers (ICs) from 2001 to 2006 were identified using screening archives, local pathology archives, and hospital discharge records. The proportional incidence of IC was determined considering breast cancers expected without screening. Three offsite radiologists experienced in breast cancer screening blindly evaluated mammograms prior to diagnosis, randomly mixed with negative mammograms (1:2 ratio). Cases unrecalled at review were considered as true ICs, those recalled by only one reviewer as minimal signs, and those recalled by two or three reviewers as missed cancers. T and N stage of the reviewed ICs were evaluated and compared.
A total of 86,276 first level mammograms were performed. Mean recall rate was 6.8% at first and 4.6% at repeat screening. We had 476 screen-detected cancers and 145 ICs (10 of them ductal carcinomas in situ). Absolute incidence was 17 per 10,000 screening examinations. Invasive proportional incidence was 19% (44/234) in the first year, 39% (91/234) in the second year, and 29% (135/468) in the two-year interval. Of 145 ICs, 130 (90%) were reviewed mixed with 287 negative controls: 55% (71/130) resulted to be true ICs, 24% (31/130) minimal signs, and 22% (28/130) missed cancers. The rate of ICs diagnosed in the first year interval was 21% (15/71) for true ICs, 46% (13/28) for missed cancers, and 39% (12/31) for minimal signs, with a significant difference of true ICs rate compared to missed cancers rate (p=0.012). A higher rate of T3 and T4 stages was found for missed cancers (18%, 5/28) compared to minimal signs (6%, 2/31) or true ICs (8%, 6/71), while the rate of N2 and N3 stage for both minimal signs (19%, 6/31) or missed cancers (25%, 7/28) was higher than that for true ICs (10%, 7/71), although all these differences were not significant (p ≥ 0.480).
These results showed the possibility to comply with European Community standards in the first years of a screening program implementation.
评估开展基于人群的乳腺 X 线摄影筛查项目以来的最初几年的表现。
邀请年龄在 49-69 岁的女性每两年接受一次双投片乳腺 X 线摄影检查，且无需仲裁进行双读片。通过筛查档案、当地病理档案和住院记录确定 2001 年至 2006 年的间期癌（IC）。考虑到无筛查情况下的预期乳腺癌发病率，确定 IC 的比例发病率。三位有乳腺 X 线摄影筛查经验的异地放射科医生在诊断前对乳腺 X 线片进行盲法评估，随机与阴性乳腺 X 线片（1:2 比例）混合。在回顾时未召回的病例被认为是真正的 IC，仅一名审阅者召回的病例被认为是微小征象，两名或三名审阅者召回的病例被认为是漏诊癌症。评估并比较了经审阅的 IC 的 T 和 N 分期。
共进行了 86276 次一级乳腺 X 线摄影检查。初次筛查的平均召回率为 6.8%，重复筛查的召回率为 4.6%。我们共发现 476 例筛查检出的癌症和 145 例 IC（其中 10 例为导管原位癌）。绝对发病率为每 10000 次筛查检查 17 例。在第一年，侵袭性比例发病率为 19%（44/234），第二年为 39%（91/234），两年间为 29%（135/468）。在 145 例 IC 中，有 130 例（90%）与 287 例阴性对照混合进行了评估：55%（71/130）为真正的 IC，24%（31/130）为微小征象，22%（28/130）为漏诊癌症。第一年间期诊断为 IC 的比例为真正的 IC 为 21%（15/71），漏诊癌症为 46%（13/28），微小征象为 39%（12/31），真正的 IC 与漏诊癌症的检出率有显著差异（p=0.012）。漏诊癌症（18%，5/28）的 T3 和 T4 期比例高于微小征象（6%，2/31）或真正的 IC（8%，6/71），而微小征象（19%，6/31）或漏诊癌症（25%，7/28）的 N2 和 N3 期比例均高于真正的 IC（10%，7/71），尽管这些差异均无统计学意义（p≥0.480）。
这些结果表明，在筛查项目实施的最初几年内，有可能符合欧洲共同体的标准。
Zotero 插件