PREVIOUS MAMMOGRAMS IN PATIENTS WITH IMPALPABLE BREAST-CARCINOMA - RETROSPECTIVE VS BLINDED INTERPRETATION
PREVIOUS MAMMOGRAMS IN PATIENTS WITH IMPALPABLE BREAST-CARCINOMA - RETROSPECTIVE VS BLINDED INTERPRETATION
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DOI：
10.2214/ajr.161.6.8249720
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发表时间：
1993-12-01
影响因子：
5
通讯作者：
INNIS, CA
中科院分区：
文献类型：
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作者：
HARVEY, JA;FAJARDO, LL;INNIS, CA
OBJECTIVE.我们研究了盲法和回顾性分析在乳腺X线检查之前获得的筛查性乳腺X线检查结果之间的差异，这些检查结果导致诊断为不可触及的乳腺癌。我们回顾了73名患者的152张既往乳房X线照片，这些患者随后在后来的乳房X线照片中发现了难以触及的乳腺癌。早期的研究以两种方式解释：（1）盲法（不知道随后检测到癌症）和（2）回顾性（与显示癌症的乳房X线照片进行比较）。然后比较两种解释在癌的存在、活检的建议、实质密度、肿瘤的组织学特征、淋巴结状态和胶片质量方面的差异。当我们对诊断性乳房X光检查前获得的乳房X光检查进行盲法审查时，先前的研究被解释为显示30名患者（41%）的癌症证据。对于其余43例患者（59%），盲态审查者将最近的既往乳房X线检查结果解释为正常或良性;然而，回顾性审查者认为其中25例患者（34%）可见癌症证据。设盲和回顾性解读之间的差异具有统计学显著性。在回顾性审查时认为存在肿瘤证据但盲态审查时不存在肿瘤证据的患者中，大多数乳腺摄影异常是最近一次检查的不对称密度。无论回顾性审查者是否认为乳腺摄影结果需要更早的活检，这都是正确的。回顾性分析乳腺X线片显示肿瘤证据的患者的组织学特征和淋巴结状态与无肿瘤证据的患者无差异。我们的研究结果表明，难以触及的乳腺癌往往是明显的，在回顾以往的乳房X线片。然而，由于许多仅表现为不对称密度，这些不一定是真正的放射学错误。在筛查性乳房X线检查中未能发现回顾性可见异常并不一定是疏忽，回顾性审查并不能反映筛查性乳房X线检查的日常实践。
OBJECTIVE. We examined differences between blinded and retrospective reviews of screening mammograms obtained before a mammogram that resulted in the diagnosis of an impalpable breast carcinoma.MATERIALS AND METHODS. We reviewed 152 previous mammograms in 73 patients in whom impalpable breast carcinomas were subsequently detected on later mammograms. The earlier studies were interpreted in two ways: (1) blindly (without knowledge that carcinoma was subsequently detected) and (2) retrospectively (with the mammogram showing the carcinoma for comparison). The two interpretations were then compared with regard to the presence of carcinoma, recommendations for biopsy, parenchymal density, histologic characteristics of the tumor, lymph node status, and film quality.RESULTS. When we did a blinded review of the mammograms obtained before the diagnostic mammograms, the previous study was interpreted as showing evidence of carcinoma in 30 patients (41%). For the remaining 43 patients (59%), the findings on the most-recent previous mammogram were interpreted as normal or benign by the blinded reviewers; however, the retrospective reviewers thought evidence of cancer was visible in 25 of these patients (34%). Differences between blinded and retrospective interpretations were statistically significant. In patients in whom evidence of tumor was thought to be present on retrospective review but not on blinded review, the majority of mammographic abnormalities were asymmetric densities on the most-recent previous examination. This was true whether or not the retrospective reviewers thought that the mammographic finding warranted earlier biopsy. The histologic characteristics and lymph node status among patients in whom mammograms were interpreted retrospectively as showing evidence of tumor were no different from those among patients with no evidence of tumor.CONCLUSION. Our results show that impalpable breast carcinomas are frequently evident in retrospect on previous mammograms. However, because many are manifested only as an asymmetric density, these may not necessarily be true radiologic errors. Failure to detect a retrospectively visible abnormality on a screening mammogram is not necessarily negligent, and retrospective reviews do not reflect the everyday practice of screening mammography.