Analysis of 172 subtle findings on prior normal mammograms in women with breast cancer detected at follow-up screening
Analysis of 172 subtle findings on prior normal mammograms in women with breast cancer detected at follow-up screening
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DOI：
10.1148/radiol.2262011634
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发表时间：
2003-02-01
期刊：
影响因子：
19.7
通讯作者：
Sickles, EA
中科院分区：
文献类型：
--
作者：
Ikeda, DM;Birdwell, RL;Sickles, EA
目的：回顾性回顾先前筛查乳房x线照片的非特异性发现，以确定哪些特征最常被认为是正常或良性的，尽管在随访筛查中发现的乳腺癌在同一部位发展。材料与方法：从13家机构收集了493对连续的乳房x光检查结果，包括最初的正常筛查结果和随后在筛查中发现的癌症（检查的平均间隔时间为14.6个月）。一位指定的放射科医生审查了每对乳房x光片，并确定了286个发现，这些发现在癌症后来发展的部位的先前检查中被认为是可见的。五名盲法放射科医生独立审查了这286例病例的先前发现，确定了169例乳房x光检查（172例癌症），这些发现非常细微，以至于五名放射科医生中没有一个或只有一两个建议召回筛查。两名无盲放射科医生审查了最初和随后的发现，并记录了每个发现的描述符和评估，以及影响病变虽然可察觉但可能未被发现或未被回忆的主观因素。结果：172例肿瘤中，129例（75%）为浸润性肿瘤（112例T1肿瘤，17例T2肿瘤或更高，中位直径为10 mm）， 43例（25%）为导管原位癌（中位直径为10 mm）。在之前的乳房x光检查中，80%（172例中的137例）的这些癌症有细微的非特异性发现，后来发展为癌症，大多数在外观上被评估为正常或良性。结论：根据大多数盲法放射科医生和非盲法审稿人的判断，有一部分癌症显示可察觉但非特异性的乳房x光检查结果，不值得召回。我们认为，未能前瞻性地对这些非特异性发现采取行动并不一定构成低于合理谨慎标准的解释。(c) rsna， 2002年。
PURPOSE: To retrospectively review nonspecific findings on prior screening mammograms to determine what features were most often deemed normal or benign despite the development of breast cancer in the same location detected at follow-up screening.MATERIALS AND METHODS: Four hundred ninety-three pairs of consecutive mammographic findings were collected from 13 institutions, consisting of initial normal screening findings and a subsequent finding of cancer at screening (mean interval between examinations, 14.6 months). One designated radiologist reviewed each pair of mammograms and determined that 286 findings were judged visible at prior examination in locations where cancer later developed. Five blinded radiologists independently reviewed the prior findings in these 286 cases, identifying 169 mammograms (172 cancers) with findings so subtle that none or only one or two of the five radiologists recommended screening recall. Two unblinded radiologists reviewed the initial and subsequent findings and recorded descriptors and assesssments for each finding and subjective factors influencing why, although the lesion, was perceptible, it might have been undetected or not recalled.RESULTS: Of 172 cancers, 129 (75%) were invasive (112 T1 tumors and 17 T2 tumors or higher; median diameter, 10 mm), and 43 (25%) were ductal carcinoma in situ (median size, 10 mm). On the prior mammograms, 80% (137 of 172) of these cancers had subtle nonspecific findings where cancer later developed, and most were assessed as being normal or benign in appearance.CONCLUSION: There is a subset of cancers that display perceptible but nonspecific mammographic findings that do not warrant recall, as judged by both a majority of blinded radiologists and by unblinded reviewers. We believe failure to act on these nonspecific findings prospectively does not necessarily constitute interpretation below a reasonable standard of care. (C) RSNA, 2002.