Blanks R G, Wallis M G, Moss S M
Cancer Screening Evaluation Unit, Institute of Cancer Research, Sutton, Surrey, UK.
J Med Screen. 1998;5(4):195-201. doi: 10.1136/jms.5.4.195.
To determine the increased cancer detection rate, if any, of programmes in the UK National Health Service breast screening programme (NHSBSP) using more than single reading of mammograms.
Information on the detection of cancers by individual screening programmes from annual (KC62) returns, supplemented by questionnaire information about the number of readers.
The 87 NHSBSP programmes from England and Wales for the screening year 1 April 1996 to 31 March 1997. The study includes all programmes for prevalent screens where two views are mandatory, but excludes the four programmes using two view mammography for incident screening.
Cancer detection, invasive cancer detection, and small (< 15 mm) invasive cancer detection by mammographic reading protocol using single reading as the reference level.
Programmes collectively using single reading detected the lowest rate of cancers at both prevalent (first) and incident (subsequent) screening. The highest rate of age standardised cancer detection was achieved by programmes using double reading with arbitration. At prevalent screens, where all programmes used two views, those programmes using double reading with arbitration detected 32% (95% confidence interval (CI) 3% to 69%) more small (< 15 mm) invasive cancers than programmes using single reading. At incident screens, where all programmes analysed used one view this increased to 73% (95% CI 40% to 113%). Recall rates showed no obvious difference between single reading and the double reading protocols, being around 7% for prevalent screens and 3.5% for incident screens.
The results suggest that the increase in cancer detection resulting from increasing the number of readers depends on the number of views, and is higher for one view than two views. Single reading of one view results in a low detection rate of small invasive cancers for most individual programmes. It is, however, recognised that a small number of individual readers may achieve high detection rates with such a protocol. All groups of programmes using different reader/view protocols are on average close to or above target cancer detection rates, except those using single reading of one view (mediolateral oblique) at incident screens.
确定英国国民医疗服务体系乳腺筛查计划（NHSBSP）中采用多次读片而非单次读片的方案是否能提高癌症检出率。
从年度（KC62）报表中获取各筛查方案的癌症检测信息，并辅以关于读片人员数量的问卷信息。
1996年4月1日至1997年3月31日筛查年度内英格兰和威尔士的87个NHSBSP方案。该研究涵盖所有强制进行双侧乳腺摄影的普查方案，但不包括四个用于病例筛查的双侧乳腺摄影方案。
以单次读片作为参考水平，通过乳腺摄影读片方案检测癌症、浸润性癌症以及微小（<15mm）浸润性癌症的情况。
总体而言，采用单次读片的方案在普查（首次）和病例（后续）筛查中癌症检出率最低。采用双读片并进行仲裁的方案年龄标准化癌症检出率最高。在普查中，所有方案均采用双侧乳腺摄影，采用双读片并进行仲裁的方案比采用单次读片的方案多检测出32%（95%置信区间（CI）3%至69%）的微小（<15mm）浸润性癌症。在病例筛查中，所有分析的方案均采用单侧乳腺摄影，这一比例增至73%（95%CI 40%至113%）。召回率在单次读片和双读片方案之间无明显差异，普查时约为7%，病例筛查时约为3.5%。
结果表明，增加读片人员数量所带来的癌症检出率提高取决于乳腺摄影的投照体位数量，对于单侧投照的提高幅度大于双侧投照。对于大多数个体方案而言，单次读片单侧投照导致微小浸润性癌症的检出率较低。然而，公认的是少数个体读片人员采用这种方案可能会获得较高的检出率。除了在病例筛查中采用单次读片单侧（内外斜位）投照的方案外，所有采用不同读片人员/投照体位方案的组平均接近或高于目标癌症检出率。
