Klompenhouwer Elisabeth G, Duijm Lucien E M, Voogd Adri C, den Heeten Gerard J, Strobbe Luc J, Louwman Marieke W, Coebergh Jan Willem, Venderink Dick, Broeders Mireille J M
Department of Radiology, Catharina Hospital, PO Box 1350, 5602 ZA, Eindhoven, The Netherlands,
Breast Cancer Res Treat. 2014 Jun;145(2):429-37. doi: 10.1007/s10549-014-2959-x. Epub 2014 Apr 19.
We determined the re-attendance rate at screening mammography after a single or a repeated false positive recall and we assessed the effects of transition from screen-film mammography (SFM) to full-field digital mammography (FFDM) on screening outcome in women recalled twice for the same mammographic abnormality. The study population consisted of a consecutive series of 302,912 SFM and 90,288 FFDM screens. During a 2 years follow-up period (until the next biennial screen), we collected the breast imaging reports and biopsy results of all recalled women. Re-attendance at biennial screening mammography was 93.2 % (95 % CI 93.1-93.3 %) for women with a negative screen (i.e., no recall at screening mammography), 65.4 % (95 % CI 64.0-66.8 %) for women recalled once, 56.7 % (95 % CI 47.1-66.4 %) for women recalled twice but for different lesions and 44.3 % (95 % CI 31.4-57.1 %) for women recalled twice for the same lesion. FFDM recalls comprised a significantly larger proportion of women who had been recalled twice for the same lesion (1.9 % of recalls (52 women) at FFDM vs. 0.9 % of recalls (37 women) at SFM, P < 0.001) and the positive predictive value of these recalls (PPV) was significantly lower at FFDM (15.4 vs. 35.1 %, P = 0.03). At review, 20 of 52 women (39.5 %, all with benign outcome) would not have been recalled for a second time at FFDM if the previous hard copy SFM screen had been available for comparison. We conclude that a repeated false positive recall for the same lesion significantly lowered the probability of screening re-attendance. The first round of FFDM significantly increased the proportion of women recalled twice for the same lesion, with a significantly lower PPV of these lesions. Almost 40 % of repeatedly recalled women would not have been recalled the second time if the previous hard copy SFM screen had been available for comparison at the time of FFDM.
我们确定了单次或重复假阳性召回后乳腺钼靶筛查的再次就诊率，并评估了从屏-片乳腺钼靶（SFM）过渡到全数字化乳腺钼靶（FFDM）对因同一乳腺钼靶异常被召回两次的女性筛查结果的影响。研究人群包括连续的302,912例SFM筛查和90,288例FFDM筛查。在2年的随访期内（直到下一次两年一次的筛查），我们收集了所有被召回女性的乳腺影像报告和活检结果。阴性筛查结果（即乳腺钼靶筛查时未被召回）的女性两年一次乳腺钼靶筛查的再次就诊率为93.2%（95%可信区间93.1 - 93.3%），被召回一次的女性为65.4%（95%可信区间64.0 - 66.8%），因不同病变被召回两次的女性为56.7%（95%可信区间47.1 - 66.4%），因同一病变被召回两次的女性为44.3%（95%可信区间31.4 - 57.1%）。FFDM召回中，因同一病变被召回两次的女性比例显著更高（FFDM召回中有1.9%（52名女性），而SFM召回中有0.9%（37名女性），P < 0.001），且这些召回的阳性预测值（PPV）在FFDM时显著更低（分别为15.4%和35.1%，P = 0.03）。复查时，如果之前的硬拷贝SFM筛查可供比较，52名女性中的20名（39.5%，所有结果均为良性）在FFDM时不会被再次召回。我们得出结论，因同一病变的重复假阳性召回显著降低了筛查再次就诊的概率。第一轮FFDM显著增加了因同一病变被召回两次的女性比例，且这些病变的PPV显著更低。如果在FFDM时能获得之前的硬拷贝SFM筛查以供比较，近40%被重复召回的女性不会被第二次召回。
