Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands.
Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands.
Breast. 2023 Jun;69:431-440. doi: 10.1016/j.breast.2023.05.001. Epub 2023 May 3.
In Dutch breast cancer screening, solitary, new or growing well-circumscribed masses should be recalled for further assessment. This results in cancers detected but also in false positive recalls, especially at initial screening. The aim of this study was to determine characteristics of well-circumscribed masses at mammography and identify potential methods to improve the recall strategy.
A systematic literature search was performed using PubMed. In addition, follow-up data were retrieved on all 8860 recalled women in a Dutch screening region from 2014 to 2019.
Based on 15 articles identified in the literature search, we found that probably benign well-circumscribed masses that were kept under surveillance had a positive predictive value (PPV) of 0-2%. New or enlarging solitary well-circumscribed masses had a PPV of 10-12%. In general the detected carcinomas had a favorable prognosis. In our exploration of screening practice, 25% of recalls (2133/8860) were triggered by a well-circumscribed mass. Those recalls had a PPV of 2.0% for initial and 10.6% for subsequent screening. Most detected carcinomas had a favorable prognosis as well.
To recognize malignancies presenting as well-circumscribed masses, identifying solitary, new or growing lesions is key. This information is missing at initial screening since prior examinations are not available, leading to a low PPV. Access to prior clinical examinations may therefore improve this PPV. In addition, given the generally favorable prognosis of screen-detected malignant well-circumscribed masses, one may opt to recall these lesions at subsequent screening, if grown, rather than at initial screening.
在荷兰乳腺癌筛查中，应召回新出现或持续生长的孤立性、边界清晰的肿块进行进一步评估。这会导致癌症的检出，也会导致假阳性召回，尤其是在初始筛查时。本研究旨在确定乳腺 X 线摄影中边界清晰肿块的特征，并确定可能改进召回策略的方法。
使用 PubMed 进行了系统的文献检索。此外，还检索了 2014 年至 2019 年荷兰某筛查地区所有 8860 名召回女性的随访数据。
根据文献检索中确定的 15 篇文章，我们发现处于监测状态的可能良性边界清晰的肿块保持不变，其阳性预测值（PPV）为 0-2%。新出现或增大的孤立性边界清晰肿块的 PPV 为 10-12%。一般来说，检出的癌具有良好的预后。在我们对筛查实践的探索中，25%的召回（2133/8860）是由边界清晰的肿块引起的。这些召回在初始筛查时的 PPV 为 2.0%，在后续筛查时的 PPV 为 10.6%。大多数检出的癌也具有良好的预后。
为了识别以边界清晰的肿块为表现的恶性肿瘤，识别孤立性、新出现或生长的病变是关键。由于无法获得之前的检查，初始筛查时缺少这些信息，导致 PPV 较低。因此，获得之前的临床检查可能会提高这个 PPV。此外，鉴于边界清晰的肿块在筛查中检测到的恶性肿瘤通常具有良好的预后，因此如果这些病变在后续筛查中生长，而不是在初始筛查中，就可以选择召回这些病变。
