Roman M, Skaane P, Hofvind S
Cancer Registry of Norway, Oslo, Norway; Department of Women and Children's Health, Oslo University Hospital, Oslo, Norway.
Department of Radiology, Oslo University Hospital Ullevaal, University of Oslo, Oslo, Norway.
Eur J Radiol. 2014 Sep;83(9):1639-44. doi: 10.1016/j.ejrad.2014.05.038. Epub 2014 Jun 5.
Recall for assessment in mammographic screening entails an inevitable number of false-positive screening results. This study aimed to investigate the variation in the cumulative risk of a false positive screening result and the positive predictive value across the screening centres in the Norwegian Breast Cancer Screening Program.
We studied 618,636 women aged 50-69 years who underwent 2,090,575 screening exams (1996-2010. Recall rate, positive predictive value, rate of screen-detected cancer, and the cumulative risk of a false positive screening result, without and with invasive procedures across the screening centres were calculated. Generalized linear models were used to estimate the probability of a false positive screening result and to compute the cumulative false-positive risk for up to ten biennial screening examinations.
The cumulative risk of a false-positive screening exam varied from 10.7% (95% CI: 9.4-12.0%) to 41.5% (95% CI: 34.1-48.9%) across screening centres, with a highest to lowest ratio of 3.9 (95% CI: 3.7-4.0). The highest to lowest ratio for the cumulative risk of undergoing an invasive procedure with a benign outcome was 4.3 (95% CI: 4.0-4.6). The positive predictive value of recall varied between 12.0% (95% CI: 11.0-12.9%) and 19.9% (95% CI: 18.3-21.5%), with a highest to lowest ratio of 1.7 (95% CI: 1.5-1.9).
A substantial variation in the performance measures across the screening centres in the Norwegian Breast Cancer Screening Program was identified, despite of similar administration, procedures, and quality assurance requirements. Differences in the readers' performance is probably of influence for the variability. This results underscore the importance of continuous surveillance of the screening centres and the radiologists in order to sustain and improve the performance and effectiveness of screening programs.
在乳腺钼靶筛查中，召回进行评估不可避免地会产生一定数量的假阳性筛查结果。本研究旨在调查挪威乳腺癌筛查项目中各筛查中心假阳性筛查结果的累积风险以及阳性预测值的差异。
我们研究了618,636名年龄在50 - 69岁之间的女性，她们接受了2,090,575次筛查（1996 - 2010年）。计算了各筛查中心的召回率、阳性预测值、筛查发现癌症的比率以及有无侵入性检查情况下假阳性筛查结果的累积风险。使用广义线性模型估计假阳性筛查结果的概率，并计算多达十次两年一次筛查检查的累积假阳性风险。
各筛查中心假阳性筛查检查的累积风险在10.7%（95%置信区间：9.4 - 12.0%）至41.5%（95%置信区间：34.1 - 48.9%）之间，最高与最低比率为3.9（95%置信区间：3.7 - 4.0）。良性结果的侵入性检查累积风险的最高与最低比率为4.3（95%置信区间：4.0 - 4.6）。召回的阳性预测值在12.0%（95%置信区间：11.0 - 12.9%）至19.9%（95%置信区间：18.3 - 21.5%）之间，最高与最低比率为1.7（95%置信区间：1.5 - 1.9）。
尽管管理、程序和质量保证要求相似，但在挪威乳腺癌筛查项目中各筛查中心的性能指标存在显著差异。阅片者表现的差异可能是造成这种变异性的原因。这些结果强调了持续监测筛查中心和放射科医生的重要性，以便维持和提高筛查项目的性能及有效性。
