Le Michelle T, Mothersill Carmel E, Seymour Colin B, McNeill Fiona E
Medical Physics & Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada.
Br J Radiol. 2016 Sep;89(1065):20160045. doi: 10.1259/bjr.20160045. Epub 2016 Jun 8.
The practice of investigating pathological abnormalities in the breasts of females who are asymptomatic is primarily employed using X-ray mammography. The importance of breast screening is reflected in the mortality-based benefits observed among females who are found to possess invasive breast carcinoma prior to the manifestation of clinical symptoms. It is estimated that population-based screening constitutes a 17% reduction in the breast cancer mortality rate among females affected by invasive breast carcinoma. In spite of the significant utility that screening confers in those affected by invasive cancer, limitations associated with screening manifest as potential harms affecting individuals who are free of invasive disease. Disease-free and benign tumour-bearing individuals who are subjected to diagnostic work-up following a screening examination constitute a population of cases referred to as false positives (FPs). This article discusses factors contributing to the FP rate in mammography and extends the discussion to an assessment of the consequences associated with FP reporting. We conclude that the mammography FP rate in North America is in excess based upon the observation of overtreatment of in situ lesions and the disproportionate distribution of detriment and benefit among the population of individuals recalled for diagnostic work-up subsequent to screening. To address the excessive incidence of FPs in mammography, we investigate solutions that may be employed to remediate the current status of the FP rate. Subsequently, it can be suggested that improvements in the breast-screening protocol, medical litigation risk, image interpretation software and the implementation of image acquisition modalities that overcome superimposition effects are promising solutions.
对无症状女性乳房的病理异常进行检查的实践主要采用X线乳房造影术。乳房筛查的重要性体现在，在临床症状出现之前被发现患有浸润性乳腺癌的女性中，基于死亡率的获益得以体现。据估计，基于人群的筛查使浸润性乳腺癌女性的乳腺癌死亡率降低了17%。尽管筛查对那些患有浸润性癌症的人有显著作用，但筛查的局限性表现为对无浸润性疾病个体的潜在危害。在筛查检查后接受诊断性检查的无疾病和患有良性肿瘤的个体构成了一类被称为假阳性（FP）的病例群体。本文讨论了导致乳房造影假阳性率的因素，并将讨论扩展到对与假阳性报告相关后果的评估。我们得出结论，基于对原位病变过度治疗的观察以及在筛查后被召回进行诊断性检查的人群中损害与获益的不均衡分布，北美乳房造影的假阳性率过高。为了解决乳房造影中过高的假阳性发生率，我们研究了可用于改善当前假阳性率状况的解决方案。随后，可以提出改进乳房筛查方案、医疗诉讼风险、图像解读软件以及实施克服叠加效应的图像采集方式是有前景的解决方案。
