Section Chief of Breast Imaging, Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Director of Breast Imaging, Fred Hutchinson Cancer Center, Seattle, Washington.
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
J Am Coll Radiol. 2024 Nov;21(11):1722-1732. doi: 10.1016/j.jacr.2024.06.020. Epub 2024 Jul 3.
Mammography and MRI screening typically occur in combination or in alternating sequence. We compared multimodality screening performance accounting for the relative timing of mammography and MRI and overlapping follow-up periods.
We identified 8,260 screening mammograms performed 2005 to 2017 in the Breast Cancer Surveillance Consortium, paired with screening MRIs within ±90 days (combined screening) or 91 to 270 days (alternating screening). Performance for combined screening (cancer detection rate [CDR] per 1,000 examinations and sensitivity) was calculated with 1-year follow-up for each modality, and with a single follow-up period treating the two tests as a single test. Alternating screening performance was calculated with 1-year follow-up for each modality and also with follow-up ending at the next screen if within 1 year (truncated follow-up).
For 3,810 combined screening pairs, CDR per 1,000 screens was 6.8 (95% confidence interval [CI]: 4.6-10.0) for mammography and 12.3 (95% CI: 9.3-16.4) for MRI as separate tests compared with 13.1 (95% CI: 10.0-17.3) as a single combined test. Sensitivity of each test was 48.1% (35.0%-61.5%) for mammography and 79.7% (95% CI: 67.7%-88.0%) for MRI compared with 96.2% (95% CI: 85.9%-99.0%) for combined screening. For 4,450 alternating screening pairs, mammography CDR per 1,000 screens changed from 3.6 (95% CI: 2.2-5.9) to zero with truncated follow-up; sensitivity was incalculable (denominator = 0). MRI CDR per 1,000 screens changed from 12.1 (95% CI 9.3-15.8) to 11.7 (95% CI: 8.9-15.3) with truncated follow-up; sensitivity changed from 75.0% (95% CI 63.8%-83.6%) to 86.7% (95% CI 75.5%-93.2%).
Updating auditing approaches to account for combined and alternating screening sequencing and to address outcome attribution issues arising from overlapping follow-up periods can improve the accuracy of multimodality screening performance evaluation.
乳腺 X 线摄影术和 MRI 筛查通常联合或交替进行。我们比较了考虑乳腺 X 线摄影术和 MRI 相对时间以及重叠随访期的多模态筛查表现。
我们在乳腺癌监测联盟中确定了 8260 例 2005 年至 2017 年进行的筛查性乳腺 X 线摄影术，与 ±90 天内（联合筛查）或 91 至 270 天内（交替筛查）进行的筛查性 MRI 配对。对于联合筛查（每 1000 例检查的癌症检出率[CDR]和敏感性），每种检查方法均进行 1 年随访，并通过将两种检查视为单次检查来计算单次随访期。对于交替筛查，对每种检查方法进行 1 年随访，并在 1 年内（截断随访）下一次筛查时结束随访。
对于 3810 对联合筛查对，单独进行乳腺 X 线摄影术和 MRI 的每 1000 次筛查的 CDR 分别为 6.8（95%置信区间[CI]：4.6-10.0）和 12.3（95% CI：9.3-16.4），而单次联合检查的 CDR 为 13.1（95% CI：10.0-17.3）。对于每个检查，乳腺 X 线摄影术的敏感性为 48.1%（35.0%-61.5%），MRI 为 79.7%（95% CI：67.7%-88.0%），而联合筛查的敏感性为 96.2%（95% CI：85.9%-99.0%）。对于 4450 对交替筛查对，截断随访时，乳腺 X 线摄影术每 1000 次筛查的 CDR 从 3.6（95% CI：2.2-5.9）变为 0；无法计算敏感性（分母=0）。MRI 每 1000 次筛查的 CDR 从 12.1（95% CI 9.3-15.8）变为截断随访时的 11.7（95% CI：8.9-15.3）；敏感性从 75.0%（95% CI 63.8%-83.6%）变为 86.7%（95% CI 75.5%-93.2%）。
更新审核方法，以考虑联合和交替筛查的测序，并解决重叠随访期引起的结果归因问题，这可以提高多模态筛查性能评估的准确性。
