Department of Radiology, Elisabeth-Tweesteden Hospital (ETZ), 90151, 5000 LC, Tilburg, The Netherlands.
Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
Eur Radiol. 2019 Jan;29(1):337-344. doi: 10.1007/s00330-018-5586-9. Epub 2018 Jun 25.
To analyse which mammographic and tumour characteristics led to concordant versus discordant recalls at blinded double reading to further optimise our breast cancer screening programme.
We included a consecutive series of 99,013 screening mammograms obtained between July 2013 and January 2015. All mammograms were double read in a blinded fashion. Discordant readings were routinely recalled without consensus or arbitration. During the 2-year follow-up, relevant data of the recalled women were collected. We compared mammographic characteristics, screening outcome and tumour characteristics between concordant and discordant recalls.
There were 2,543 concordant recalls (71.4%) and 997 discordant recalls (28.0%). The positive predictive value of a concordant recall was significantly higher (23.5% vs. 10.0%, p < 0.001). The proportion of BI-RADS 0 was significantly higher in the discordant recall group (75.7% vs. 56.3%, p < 0.001). Discordant recalls were more often an asymmetry or architectural distortion (21.8% vs. 13.2% and 9.3% vs. 6.5%, respectively, p < 0.001). There were no differences in the distribution of DCIS and invasive cancers and tumour characteristics were comparable for the two groups, except for a more favourable tumour grade in the discordant recall group (54.7% vs. 39.9% grade I tumours, p = 0.022).
Screen-detected cancers detected by a discordant reading show a more favourable tumour grade than cancers diagnosed after a concordant recall. The higher proportion of asymmetries and architectural distortions in this group provide a possible target for improving screening programmes by additional training of screening radiologists and the implementation of digital breast tomosynthesis.
• With blinded double reading of screening mammograms, screen-detected cancers detected by a discordant reading show a more favourable tumour grade than cancers diagnosed after a concordant recall. • The proportions of asymmetries and architectural distortions are higher in case of a discordant reading. • Possible improvement strategies could target additional training of screening radiologists and the implementation of digital breast tomosynthesis in breast cancer screening programmes.
分析在盲法双读中导致一致或不一致召回的乳腺影像学和肿瘤特征，以进一步优化我们的乳腺癌筛查计划。
我们纳入了 2013 年 7 月至 2015 年 1 月期间连续的 99013 例筛查性乳腺 X 线摄影。所有乳腺 X 线摄影均以盲法进行双读。不一致的读片结果通常在没有共识或仲裁的情况下进行召回。在 2 年的随访期间，收集了召回女性的相关数据。我们比较了一致和不一致召回之间的乳腺影像学特征、筛查结果和肿瘤特征。
有 2543 例（71.4%）一致召回和 997 例（28.0%）不一致召回。一致召回的阳性预测值显著更高（23.5%比 10.0%，p < 0.001）。不一致召回组 BI-RADS 0 的比例显著更高（75.7%比 56.3%，p < 0.001）。不一致召回更常见的是不对称或结构扭曲（21.8%比 13.2%和 9.3%比 6.5%，分别为，p < 0.001）。DCIS 和浸润性癌症的分布无差异，两组肿瘤特征相似，但不一致召回组的肿瘤分级更有利（54.7%比 39.9%为 I 级肿瘤，p = 0.022）。
通过不一致读片检出的筛查性癌症比通过一致读片检出的癌症具有更有利的肿瘤分级。该组中更常见的不对称和结构扭曲提供了通过额外的筛查放射科医生培训和实施数字乳腺断层合成术来改善筛查计划的可能目标。
在筛查性乳腺 X 线摄影的盲法双读中，通过不一致读片检出的筛查性癌症比通过一致读片检出的癌症具有更有利的肿瘤分级。
不一致读片的不对称和结构扭曲比例更高。
可能的改进策略可以针对筛查放射科医生的额外培训和数字乳腺断层合成术在乳腺癌筛查计划中的实施。
