van der Veer Eline L, Rozemond Fenna, Generaal Manon I, Bluekens Adriana M J, Coolen Angela M P, Voogd Adri C, Duijm Lucien E M
Elisabeth TweeSteden Hospital, Hilvarenbeekse Weg 60, 5022 GC, Tilburg, The Netherlands.
Erasmus Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
Eur Radiol. 2024 Dec 21. doi: 10.1007/s00330-024-11302-5.
Quality control in breast cancer screening programmes has been subject of several studies. However, less is known about the clinical diagnostic work-up in recalled women with a suspicious finding at screening mammography. The current study focuses on interhospital differences in diagnostic work-up strategies.
In this retrospective analysis, using a prospectively obtained database, we included 17,809 women who participated in the Dutch national screening programme between 2009 and 2019 and were recalled to a hospital for analysis of a suspicious mammographic abnormality. The diagnostic work-up (e.g., type and frequency of additional imaging and biopsy) in the different hospitals were compared and analysed by multivariable analysis to correct for confounders.
Use of biopsy varied from 36.7% to 48.7% (p < 0.001) between hospitals, and the use of problem-solving magnetic resonance imaging (MRI) from 2.1% to 6.9% (p < 0.001). These interhospital differences remained after correction for patients and tumour characteristics. The percentage of women with a delayed breast cancer diagnosis, defined as histopathological confirmation of breast cancer more than three months after recall or first analysis in the hospital, varied from 2.7% to 6.1% between hospitals (p = 0.07).
In our screening region interhospital differences were observed in diagnostic work-up following recall at biennial screening mammography. Though statistically significant, absolute differences were small, and therefore, their clinical impact appears to be limited.
Question It is unclear how diagnostic work-up strategies vary between hospitals for women recalled after suspicious findings in breast cancer screening. Findings Significant differences in biopsy techniques and the use of problem-solving MRI were observed, though the clinical impact of these variations is likely to be marginal. Clinical relevance Evaluation of interhospital variation in the diagnostic work-up strategies after recall may aid in optimising the quality of breast cancer care and, indirectly, the effectiveness of the screening programme.
乳腺癌筛查项目中的质量控制已成为多项研究的主题。然而，对于在乳腺钼靶筛查中发现可疑结果而被召回的女性的临床诊断检查，我们了解得较少。当前研究聚焦于不同医院在诊断检查策略上的差异。
在这项回顾性分析中，我们使用一个前瞻性获取的数据库，纳入了2009年至2019年间参与荷兰国家筛查项目且因乳腺钼靶检查发现可疑异常而被召回医院进行分析的17809名女性。通过多变量分析比较并分析不同医院的诊断检查（如额外影像学检查和活检的类型及频率），以校正混杂因素。
不同医院活检的使用比例在36.7%至48.7%之间（p < 0.001），解决问题的磁共振成像（MRI）的使用比例在2.1%至6.9%之间（p < 0.001）。在校正患者和肿瘤特征后，这些医院间差异依然存在。乳腺癌诊断延迟的女性比例，定义为在召回或首次在医院分析后超过三个月才获得乳腺癌组织病理学确诊，不同医院之间在2.7%至6.1%之间（p = 0.07）。
在我们的筛查区域，两年一次的乳腺钼靶筛查召回后的诊断检查中观察到了医院间差异。尽管差异具有统计学意义，但绝对差异较小，因此，它们的临床影响似乎有限。
问题尚不清楚乳腺癌筛查中发现可疑结果后被召回的女性，不同医院的诊断检查策略有何不同。发现活检技术和解决问题的MRI的使用存在显著差异，尽管这些差异的临床影响可能微乎其微。临床相关性评估召回后诊断检查策略的医院间差异，可能有助于优化乳腺癌护理质量，并间接提高筛查项目的有效性。
