The "Sweet Spot" Revisited: Optimal Recall Rates for Cancer Detection With 2D and 3D Digital Screening Mammography in the Metro Chicago Breast Cancer Registry.
The "Sweet Spot" Revisited: Optimal Recall Rates for Cancer Detection With 2D and 3D Digital Screening Mammography in the Metro Chicago Breast Cancer Registry.
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DOI：
10.2214/ajr.19.22429
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
Alsheik NH
中科院分区：
文献类型：
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作者：
Rauscher GH;Murphy AM;Qiu Q;Dolecek TA;Tossas K;Liu Y;Alsheik NH
与乳房X光摄影质量有关的一个中心问题涉及识别最佳召回率，以最大限度地检测癌症，同时最大限度地减少不必要的下游诊断成像和乳房活检。我们研究了在单一大型医疗保健组织中，在活检建议和癌症检测方面为了更高的召回率而进行的权衡。我们纳入了2005年1月1日至2017年12月31日期间对40-79岁女性进行的2D模拟、2D数字和3D数字(断层合成)筛查乳房X光检查，并对癌症进行了跟踪调查，直至2018年。有36名、67名和38名放射科医生分别阅读了至少1000次2D模拟检查、2D数字检查和3D断层合成检查，这些分析包括在内。使用带有边际标准化的Logistic回归，我们估计了放射科医生特定的平均回忆(异常解释/1000乳房X光检查)、活检建议、癌症检测(筛查-原位和浸润性癌症/1000乳房X光检查)，以及微创癌症检测率，同时调整了患者特征的差异。在1060,655张筛查乳房X光照片中，平均召回率为10.7%，癌症发现率为4.0/1000，活检推荐率为1.60%。召回率在7%到9%之间似乎可以最大限度地提高癌症的检测能力，同时最大限度地减少不必要的活检。这项调查的结果与最近一项研究的结果形成了鲜明对比，该研究表明，较高的召回率是合适的。对于2D数字乳房X光照相和3D断层合成，最佳癌症检测的“甜蜜点”似乎都在7-9%的召回率范围内。太多的女性被召回接受诊断成像，可以设定新的基准来减轻这一负担。
One central question pertaining to mammography quality relates to discerning the optimal recall rate to maximize cancer detection while minimizing unnecessary downstream diagnostic imaging and breast biopsies. We examined the trade-offs for higher recall rates in terms of biopsy recommendations and cancer detection in a single large health care organization. We included 2D analog, 2D digital, and 3D digital (tomosynthesis) screening mammography examinations among women 40–79 years old performed between January 1, 2005, and December 31, 2017, with cancer follow-up through 2018. There were 36, 67, and 38 radiologists who read at least 1000 2D analog examinations, 2D digital examinations, and 3D tomosynthesis examinations, respectively, who were included in these analyses. Using logistic regression with marginal standardization, we estimated radiologist-specific mean recall (abnormal interpretations/1000 mammograms), biopsy recommendation, cancer detection (screening-detected in situ and invasive cancers/1000 mammograms), and minimally invasive cancer detection rates while adjusting for differences in patient characteristics. Among 1,060,655 screening mammograms, the mean recall rate was 10.7%, the cancer detection rate was 4.0/1000 mammograms, and the biopsy recommendation rate was 1.60%. Recall rates between 7% and 9% appeared to maximize cancer detection while minimizing unnecessary biopsies. The results of this investigation are in contrast to those of a recent study suggesting appropriateness of higher recall rates. The “sweet spot” for optimal cancer detection appears to be in the recall rate range of 7–9% for both 2D digital mammography and 3D tomosynthesis. Too many women are being called back for diagnostic imaging, and new benchmarks could be set to reduce this burden.