Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA.
Fred Hutchinson Cancer Center, Seattle, WA, USA.
Korean J Radiol. 2023 Aug;24(8):729-738. doi: 10.3348/kjr.2022.1038.
When multiple surveillance mammograms are performed within an annual interval, the current guidance for one-year follow-up to determine breast cancer status results in shared follow-up periods in which a single breast cancer diagnosis can be attributed to multiple preceding examinations, posing a challenge for standardized performance assessment. We assessed the impact of using follow-up periods that eliminate the artifactual inflation of second breast cancer diagnoses.
We evaluated surveillance mammograms from 2007-2016 in women with treated breast cancer linked with tumor registry and pathology outcomes. Second breast cancers included ductal carcinoma in situ or invasive breast cancer diagnosed during one-year follow-up. The cancer detection rate, interval cancer rate, sensitivity, and specificity were compared using different follow-up periods: standard one-year follow-up per the American College of Radiology versus follow-up that was shortened at the next surveillance mammogram if less than one year (truncated follow-up). Performance measures were calculated overall and by indication (screening, evaluation for breast problem, and short interval follow-up).
Of 117971 surveillance mammograms, 20% (n = 23533) were followed by another surveillance mammogram within one year. Standard follow-up identified 1597 mammograms that were associated with second breast cancers. With truncated follow-up, the breast cancer status of 179 mammograms (11.2%) was revised, resulting in 1418 mammograms associated with unique second breast cancers. The interval cancer rate decreased with truncated versus standard follow-up (3.6 versus 4.9 per 1000 mammograms, respectively), with a difference (95% confidence interval [CI]) of -1.3 (-1.6, -1.1). The overall sensitivity increased to 70.4% from 63.7%, for the truncated versus standard follow-up, with a difference (95% CI) of 6.6% (5.6%, 7.7%). The specificity remained stable at 98.1%.
Truncated follow-up, if less than one year to the next surveillance mammogram, enabled second breast cancers to be associated with a single preceding mammogram and resulted in more accurate estimates of diagnostic performance for national benchmarks.
当在一年内进行多次监测乳房 X 光检查时，目前的一年随访指南用于确定乳腺癌状态，导致了多个随访期重叠，其中单个乳腺癌诊断可能归因于多个先前的检查，这对标准化绩效评估构成了挑战。我们评估了使用消除第二乳腺癌诊断人为膨胀的随访期的影响。
我们评估了 2007 年至 2016 年期间患有经治疗乳腺癌的女性的监测乳房 X 光检查，这些女性与肿瘤登记处和病理结果相关联。第二乳腺癌包括在一年随访期间诊断出的导管原位癌或浸润性乳腺癌。使用不同的随访期（美国放射学院的标准一年随访与下一次监测乳房 X 光检查时不到一年的随访缩短）比较了癌症检出率、间隔期癌症率、敏感性和特异性。总体和按适应证（筛查、乳房问题评估和短间隔随访）计算了性能指标。
在 117971 次监测乳房 X 光检查中，20%（n=23533）在一年内进行了另一项监测乳房 X 光检查。标准随访确定了 1597 次与第二乳腺癌相关的乳房 X 光检查。使用缩短的随访，179 次乳房 X 光检查（11.2%）的乳腺癌状态被修改，导致 1418 次与独特的第二乳腺癌相关的乳房 X 光检查。与标准随访相比，缩短随访的间隔期癌症率降低（分别为每 1000 次乳房 X 光检查 3.6 与 4.9），差异（95%置信区间[CI]）为-1.3（-1.6，-1.1）。与标准随访相比，截断随访的总体敏感性从 63.7%提高到 70.4%，差异（95%CI）为 6.6%（5.6%，7.7%）。特异性保持稳定在 98.1%。
如果下一次监测乳房 X 光检查不到一年，则缩短随访时间，可以使第二乳腺癌与单个先前的乳房 X 光检查相关联，并为国家基准提供更准确的诊断性能估计。
