From the Department of Radiology, Elisabeth-Tweesteden Hospital, PO Box 90151, 5000 LC, Tilburg, the Netherlands (A.M.P.C., H.W.B.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (B.K.); Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Center, Maastricht, the Netherlands (V.C.G.T.); Department of Epidemiology, Maastricht University, GROW, Maastricht, the Netherlands (A.C.V.); Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands (A.C.V.); Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (L.E.M.D.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (L.E.M.D.).
Radiology. 2020 Mar;294(3):509-517. doi: 10.1148/radiol.2019191388. Epub 2020 Jan 7.
Background Screening technologists may function as readers in breast cancer screening programs. In the Netherlands, they attend quality assurance sessions. The frequency and characteristics of additional breast cancers detected through these sessions have not been reported. Purpose To determine the frequency and characteristics of cancers detected through quality assurance sessions. Materials and Methods This secondary analysis of a prospective cohort included 466 647 screening mammograms obtained between January 1, 2009, and January 1, 2017. Mammograms were single read by certified screening technologists before being double read by two certified screening radiologists who were not blinded to the technologists' reading. The technologists and a coordinating screening radiologist regularly discussed mammograms that the technologists considered suspicious but that did not prompt recall at radiologist double reading. The coordinating radiologist decided whether secondary recall was indicated. During a 2-year follow-up, radiologic and pathologic outcome data for all recalled women were obtained. Characteristics of cancers detected at radiologist double reading and those detected through quality assurance sessions were compared by using χ and Fisher exact tests. Results A total of 14 142 women (mean age, 59 years ± 7.8 [standard deviation]; range, 49-75 years) were recalled (recall rate, 3.0% [14 142 of 466 647]): 14 057 after radiologist double reading and 85 by the coordinating radiologists after quality assurance sessions. This resulted in 3156 screening-detected cancers (6.8 cancers detected per 1000 screenings), of which 26 (0.8% of screening-detected cancers [26 of 3156]) were detected after secondary recall through quality assurance sessions. The latter comprised eight ductal carcinomas in situ (88% intermediate or high grade [seven of eight]) and 18 invasive cancers (14 T1a-c and four T2+ cancers, 89% Nottingham grade I or II [16 of 18]). No significant differences in tumor characteristics were found ( values ranging from .22 to .95). Sensitivity of quality assurance sessions for additional cancer detection was 52% (26 of 50; 95% confidence interval: 38%, 66%). Conclusion The role of quality assurance sessions in additional cancer detection is limited. Tumor characteristics did not differ significantly from those of cancers detected at radiologist double reading. © RSNA, 2020.
背景
乳腺筛查技术员可能在乳腺癌筛查项目中担任读片员。在荷兰，他们会参加质量保证会议。但目前尚未报道通过这些会议发现的额外乳腺癌的频率和特征。
目的
确定质量保证会议中发现癌症的频率和特征。
材料与方法
本研究为前瞻性队列的二次分析，纳入了 2009 年 1 月 1 日至 2017 年 1 月 1 日期间获得的 466647 例筛查性乳腺 X 线摄影。乳腺 X 线摄影在由经过认证的筛查技术员进行单读后，由两位未对技术员读片结果设盲的经过认证的筛查放射科医生进行双读。技术员和一名协调的筛查放射科医生定期讨论那些技术员认为可疑但在放射科医生双读时未提示召回的乳腺 X 线摄影。协调放射科医生决定是否需要进行二次召回。在为期 2 年的随访期间，获取了所有召回女性的放射学和病理学结果数据。使用 χ² 和 Fisher 确切检验比较了放射科医生双读和质量保证会议中发现的癌症的特征。
结果
共有 14142 名女性（平均年龄 59 岁±7.8[标准差]；范围，49-75 岁）被召回（召回率 3.0%[14142 名/466647 名]）：放射科医生双读后召回 14057 名，协调放射科医生通过质量保证会议后召回 85 名。这导致发现 3156 例筛查检出癌症（每 1000 次筛查检出 6.8 例癌症），其中 26 例（筛查检出癌症的 0.8%[26 例/3156 例]）是在质量保证会议的二次召回后检出的。后者包括 8 例导管原位癌（88%为中高级别[8 例中的 7 例]）和 18 例浸润性癌（14 例 T1a-c 和 4 例 T2+癌，诺丁汉分级 I 或 II[18 例中的 16 例]）。肿瘤特征无显著差异（ 值范围为.22 至.95）。质量保证会议对额外癌症检测的敏感性为 52%（26 例/50 例；95%置信区间：38%，66%）。
结论
质量保证会议在额外癌症检测中的作用有限。肿瘤特征与放射科医生双读时发现的癌症无显著差异。
© RSNA，2020。
