Hayward Jessica H, Ray Kimberly M, Wisner Dorota J, Kornak John, Lin Weiwen, Joe Bonnie N, Sickles Edward A
1 Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1600 Divisadero St, Rm C250, Mail Box 1667, San Francisco, CA 94115.
2 Kaiser San Rafael Medical Center, San Rafael, CA.
AJR Am J Roentgenol. 2016 Oct;207(4):918-924. doi: 10.2214/AJR.15.15917. Epub 2016 Jul 6.
The objective of the present study is to evaluate the effect of comparison with multiple prior mammograms on the outcomes of screening mammography relative to comparison with a single prior mammogram.
We retrospectively analyzed 46,288 consecutive screening mammograms performed at our institution for 22,792 women. We divided these examinations into three groups: those interpreted without comparison with prior mammograms, those interpreted in comparison with one prior examination, and those interpreted in comparison with two or more prior examinations. For each group, we determined the rate of examination recall. We also calculated the positive predictive value of recall (i.e., positive predictive value level 1 [PPV1]) and the cancer detection rate (CDR) for both the group of examinations compared with a single prior mammogram and the group compared with multiple prior mammograms. Generalized estimating equations with the logistic link function were used to determine the relative odds ratio of recall as a function of the number of comparisons, with adjustment made for age as a confounding variable. The Fisher exact test was performed to compare the PPV1 and the CDR in the different cohorts.
The recall rate for mammograms interpreted without comparison with prior examinations was 16.6%, whereas that for mammograms compared with one prior examination was 7.8% and that for mammograms compared with two or more prior examinations was 6.3%. After adjustment was made for age, the odds ratio of recall for the group with multiple prior examinations relative to the group with a single prior examination was 0.864 (95% CI, 0.776-0.962; p = 0.0074). Statistically significant increases in the PPV1 of 0.05 (p = 0.0009) and in the CDR of 2.3 cases per 1000 examinations (p = 0.0481) were also noted for mammograms compared with multiple prior examinations relative to those compared with a single prior examination.
Comparison with two or more prior mammograms resulted in a statistically significant reduction in the screening mammography recall rate and increases in the CDR and PPV1 relative to comparison with a single prior mammogram.
本研究的目的是评估与多张先前乳腺钼靶片进行比较相对于与单张先前乳腺钼靶片进行比较对乳腺钼靶筛查结果的影响。
我们回顾性分析了在本机构为22792名女性进行的46288例连续乳腺钼靶筛查。我们将这些检查分为三组：未与先前乳腺钼靶片进行比较而解读的检查、与一次先前检查进行比较而解读的检查以及与两次或更多次先前检查进行比较而解读的检查。对于每组，我们确定了检查召回率。我们还计算了召回的阳性预测值（即一级阳性预测值[PPV1]）以及与单张先前乳腺钼靶片进行比较的检查组和与多张先前乳腺钼靶片进行比较的检查组的癌症检出率（CDR）。使用具有逻辑链接函数的广义估计方程来确定作为比较次数函数的召回相对比值比，并将年龄作为混杂变量进行调整。进行Fisher精确检验以比较不同队列中的PPV1和CDR。
未与先前检查进行比较而解读的乳腺钼靶片召回率为16.6%，而与一次先前检查进行比较的乳腺钼靶片召回率为7.8%，与两次或更多次先前检查进行比较的乳腺钼靶片召回率为6.3%。在对年龄进行调整后，与多张先前检查的组相比，与单张先前检查的组的召回比值比为0.864（95%CI，0.776 - 0.962；p = 0.0074）。与单张先前乳腺钼靶片进行比较的乳腺钼靶片相比，与多张先前乳腺钼靶片进行比较的乳腺钼靶片在PPV1上也有统计学显著增加，增加了0.05（p = 0.0009），在CDR上每1000次检查增加了2.3例（p = 0.0481）。
与两次或更多次先前乳腺钼靶片进行比较相对于与单张先前乳腺钼靶片进行比较，在统计学上显著降低了乳腺钼靶筛查召回率，并提高了CDR和PPV1。
