Sprague Brian L, Conant Emily F, Onega Tracy, Garcia Michael P, Beaber Elisabeth F, Herschorn Sally D, Lehman Constance D, Tosteson Anna N A, Lacson Ronilda, Schnall Mitchell D, Kontos Despina, Haas Jennifer S, Weaver Donald L, Barlow William E
From University of Vermont, Burlington, Vermont; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Fred Hutchinson Cancer Research Center and Cancer Research and Biostatistics, Seattle, Washington; and Massachusetts General Hospital and Brigham and Women's Hospital, Boston, Massachusetts.
Ann Intern Med. 2016 Oct 4;165(7):457-464. doi: 10.7326/M15-2934. Epub 2016 Jul 19.
About half of the United States has legislation requiring radiology facilities to disclose mammographic breast density information to women, often with language recommending discussion of supplemental screening options for women with dense breasts.
To examine variation in breast density assessment across radiologists in clinical practice.
Cross-sectional and longitudinal analyses of prospectively collected observational data.
30 radiology facilities within the 3 breast cancer screening research centers of the Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium.
Radiologists who interpreted at least 500 screening mammograms during 2011 to 2013 (n = 83). Data on 216 783 screening mammograms from 145 123 women aged 40 to 89 years were included.
Mammographic breast density, as clinically recorded using the 4 Breast Imaging Reporting and Data System categories (heterogeneously dense and extremely dense categories were considered "dense" for analyses), and patient age, race, and body mass index (BMI).
Overall, 36.9% of mammograms were rated as showing dense breasts. Across radiologists, this percentage ranged from 6.3% to 84.5% (median, 38.7% [interquartile range, 28.9% to 50.9%]), with multivariable adjustment for patient characteristics having little effect (interquartile range, 29.9% to 50.8%). Examination of patient subgroups revealed that variation in density assessment across radiologists was pervasive in all but the most extreme patient age and BMI combinations. Among women with consecutive mammograms interpreted by different radiologists, 17.2% (5909 of 34 271) had discordant assessments of dense versus nondense status.
Quantitative measures of mammographic breast density were not available for comparison.
There is wide variation in density assessment across radiologists that should be carefully considered by providers and policymakers when considering supplemental screening strategies. The likelihood of a woman being told she has dense breasts varies substantially according to which radiologist interprets her mammogram.
National Institutes of Health.
美国约有一半地区有立法要求放射科向女性披露乳房X线摄影的乳腺密度信息，通常还会建议就致密乳腺女性的补充筛查方案进行讨论。
研究临床实践中放射科医生对乳腺密度评估的差异。
对前瞻性收集的观察数据进行横断面和纵向分析。
基于人群的个性化方案优化筛查（PROSPR）联盟的3个乳腺癌筛查研究中心内的30个放射科。
在2011年至2013年期间解读了至少500例筛查乳房X线照片的放射科医生（n = 83）。纳入了来自145123名40至89岁女性的216783例筛查乳房X线照片的数据。
使用4种乳腺影像报告和数据系统类别临床记录的乳房X线摄影乳腺密度（分析时将不均匀致密和极度致密类别视为“致密”），以及患者年龄、种族和体重指数（BMI）。
总体而言，36.9%的乳房X线照片被评为显示致密乳腺。在所有放射科医生中，这一百分比范围为6.3%至84.5%（中位数为38.7%[四分位间距为28.9%至50.9%]），对患者特征进行多变量调整影响不大（四分位间距为29.9%至50.8%）。对患者亚组的检查显示，除了最极端的患者年龄和BMI组合外，放射科医生对密度评估的差异在所有患者中普遍存在。在由不同放射科医生解读连续乳房X线照片的女性中，17.2%（34271例中的5909例）对致密与非致密状态的评估不一致。
无法获得乳房X线摄影乳腺密度的定量测量值进行比较。
放射科医生对密度评估存在很大差异，医疗服务提供者和政策制定者在考虑补充筛查策略时应仔细考虑。女性被告知自己乳腺致密的可能性因解读其乳房X线照片的放射科医生不同而有很大差异。
美国国立卫生研究院。
