From the Department of Surgery, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, the Netherlands (J.D.L.); School for Oncology and Developmental Biology, GROW Research Institute (J.D.L., V.C.G.T.), and Department of Epidemiology (A.C.V.), Maastricht University, Maastricht, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands (A.C.V.); Department of Breast Surgery, Amphia Hospital, Breda, the Netherlands (E.J.T.L.); Department of Health Evidence, Biostatistics Section, Radboud University Medical Centre, Nijmegen, the Netherlands (M.J.M.B., K.C.B.R.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (M.J.M.B., L.E.M.D.); Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, Maastricht, the Netherlands (V.C.G.T.); and Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (L.E.M.D.).
Radiology. 2020 Mar;294(3):528-537. doi: 10.1148/radiol.2020191266. Epub 2020 Jan 28.
Background Trends in the detection of suspicious microcalcifications at mammography screening and the yield of these lesions after recall are unknown. Purpose To determine trends in recall and outcome of screen-detected microcalcifications during 20 years of mammography screening. Materials and Methods The authors performed a retrospective analysis of a consecutive series of 817 656 screening examinations (January 1997 to January 2017) in a national breast screening program. In 2009-2010 (transition period), screen-film mammography (SFM) was gradually replaced by full-field digital mammography (FFDM). The recalls of suspicious microcalcifications from all radiology reports and pathologic outcome of recalled women with 2-year follow-up were analyzed. Screening outcome in the era of SFM (1997-2008), the transition period (2009-2010), and the era of FFDM (2011-2016) were compared. Trends over time and variations between the SFM and FFDM periods were expressed by using proportions with 95% confidence intervals (CIs). In cases where the analysis based on the CI confirmed clear periods (eg, before and after introduction of FFDM), pre- and postchange outcomes were compared by using χ tests. Results A total of 18 592 women (median age, 59 years; interquartile range, 14 years) were recalled at mammography screening, 3556 of whom had suspicious microcalcifications. The recall rate for microcalcifications increased from 0.1% in 1997-1998 to 0.5% in 2015-2016 ( < .001). This was temporally associated with the change from SFM to FFDM. The recalls yielding ductal carcinoma in situ (DCIS) increased from 0.3 per 1000 screening examinations with SFM to 1.1 per 1000 screening examinations with FFDM ( < .001), resulting in a decrease in the positive predictive value for recall for suspicious microcalcifications from 51% to 33% ( < .001). More than half of all DCIS lesions were high grade (52.6%; 393 of 747). The distribution of DCIS grades was stable during the 20-year screening period ( = .36). Conclusion The recall rate for suspicious microcalcifications at mammographic screening increased during the past 2 decades, whereas the ductal carcinoma in situ detection rate increased less rapidly, resulting in a lower positive predictive value for recall. © RSNA, 2020.
背景 在乳房 X 线筛查中可疑微钙化的检出趋势以及这些病变在召回后的检出率尚不清楚。 目的 旨在确定 20 年乳房 X 线筛查中筛查发现的微钙化的召回率和结果趋势。 材料与方法 本研究对一项全国性乳房筛查计划中连续 817656 例筛查检查（1997 年 1 月至 2017 年 1 月）进行了回顾性分析。在 2009-2010 年（过渡期），屏片乳腺摄影（SFM）逐渐被全数字化乳腺摄影（FFDM）取代。对所有放射学报告中的可疑微钙化的召回情况以及 2 年随访时召回女性的病理结果进行了分析。比较了 SFM 时代（1997-2008 年）、过渡期（2009-2010 年）和 FFDM 时代（2011-2016 年）的筛查结果。用 95%置信区间（CI）表示随时间的趋势和 SFM 与 FFDM 两个时期之间的差异。在基于 CI 的分析确认了明确时期的情况下（例如，FFDM 引入前后），使用 χ 检验比较了变化前后的结果。 结果 在乳房 X 线筛查中共有 18592 名女性（中位年龄，59 岁；四分位间距，14 岁）被召回，其中 3556 名女性的微钙化可疑。微钙化的召回率从 1997-1998 年的 0.1%上升至 2015-2016 年的 0.5%（<.001）。这与从 SFM 到 FFDM 的转变时间相关。导管原位癌（DCIS）的检出率从 SFM 每 1000 次筛查检查 0.3 例增加到 FFDM 每 1000 次筛查检查 1.1 例（<.001），导致可疑微钙化的召回阳性预测值从 51%降至 33%（<.001）。所有 DCIS 病变中超过一半为高级别（52.6%；747 例中有 393 例）。在 20 年的筛查期间，DCIS 分级的分布保持稳定（=.36）。 结论 在过去的 20 年中，乳房 X 线筛查中可疑微钙化的召回率有所增加，而 DCIS 的检出率增加速度较慢，导致召回的阳性预测值降低。
