Diagnostic imaging and biopsy pathways following abnormal screen-film and digital screening mammography.
Diagnostic imaging and biopsy pathways following abnormal screen-film and digital screening mammography.
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DOI：
10.1007/s10549-013-2466-5
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发表时间：
2013-04
影响因子：
3.8
通讯作者：
Sweet, Alison
中科院分区：
文献类型：
--
作者：
Hubbard, Rebecca A.;Zhu, Weiwei;Horblyuk, Ruslan;Karliner, Leah;Sprague, Brian L.;Henderson, Louise;Lee, David;Onega, Tracy;Buist, Diana S. M.;Sweet, Alison
从屏幕胶片到数字乳腺X射线摄影的转变可能改变了对阳性筛查检查后女性的诊断评估。本研究比较了使用屏幕胶片或数字乳腺X射线摄影筛查的妇女的诊断成像和活检的使用和及时性。数据来自2005-2008年来自22个乳腺癌监测联盟设施的32,087名40-89岁妇女的35,321例阳性筛查乳房X线照片。诊断途径按其包括诊断性乳腺X线摄影、超声、磁共振成像（MRI）和活检进行分类。我们比较了患者特征、筛查检查方式和放射学设施的诊断途径的分辨率和频率的时间。通过计算每个机构接受特定途径随访的乳房X线照片比例，并检查这些比例在机构间的变化，评估机构间差异。调整年龄、日历年和设施的多项logistic回归比较了每种途径的随访几率。阳性筛查乳房X线照片消退的中位时间为10天。与屏幕胶片乳房X线摄影相比，数字乳房X线摄影更频繁地仅进行一次诊断性乳房X线摄影（46%对36%）。数字筛查乳腺X线摄影后的路径也不太可能包括活检（16% vs. 20%）。然而，在校正分析中，大多数差异无统计学显著性（仅乳腺X线摄影p = 0.857;活检p = 0.03）。在各机构中观察到诊断途径频率的显著差异。例如，各机构仅使用诊断性乳腺X射线摄影进行评价的频率范围为23%至55%。阳性数字和屏幕胶片筛查乳腺X线片的评价差异很小，似乎主要归因于放射学设施之间的实质性差异。为了指导卫生系统努力消除不利于有效护理的做法，我们需要进一步研究来确定这种变化的原因以及最佳的循证随访方法。
The transition from screen-film to digital mammography may have altered diagnostic evaluation of women following a positive screening examination. This study compared use and timeliness of diagnostic imaging and biopsy for women screened with screen-film or digital mammography. Data were from 35,321 positive screening mammograms on 32,087 women aged 40–89 years, from 22 Breast Cancer Surveillance Consortium facilities in 2005–2008. Diagnostic pathways were classified by their inclusion of diagnostic mammography, ultrasound, magnetic resonance imaging (MRI), and biopsy. We compared time to resolution and frequency of diagnostic pathways by patient characteristics, screening exam modality, and radiology facility. Between-facility differences were evaluated by computing the proportion of mammograms receiving follow-up with a particular pathway for each facility and examining variation in these proportions across facilities. Multinomial logistic regression adjusting for age, calendar year, and facility compared odds of follow-up with each pathway. The median time to resolution of a positive screening mammogram was 10 days. Compared to screen-film mammograms, digital mammograms were more frequently followed by only a single diagnostic mammogram (46% vs. 36%). Pathways following digital screening mammography were also less likely to include biopsy (16% vs. 20%). However, in adjusted analyses most differences were not statistically significant (p = 0.857 for mammography only; p = 0.03 for biopsy). Substantial variability in diagnostic pathway frequency was seen across facilities. For instance, the frequency of evaluation with diagnostic mammography alone ranged from 23% to 55% across facilities. Differences in evaluation of positive digital and screen-film screening mammograms were minor, and appeared to be largely attributable to substantial variation between radiology facilities. To guide health systems in their efforts to eliminate practices that do not contribute to effective care, we need further research to identify the causes of this variation and the best evidence-based approach for follow-up.
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影响因子：
1.9
作者：
Smith, RA;Duffy, SW;Chen, THH
通讯作者：
Chen, THH
影响因子：
39.2
作者：
Kerlikowske K;Hubbard RA;Miglioretti DL;Geller BM;Yankaskas BC;Lehman CD;Taplin SH;Sickles EA;Breast Cancer Surveillance Consortium
通讯作者：
Breast Cancer Surveillance Consortium
影响因子：
3
作者：
Hubbard RA;Zhu W;Onega TL;Fishman P;Henderson LM;Tosteson AN;Buist DS
通讯作者：
Buist DS
影响因子：
19.7
作者：
Pisano, Etta D.;Hendrick, R. Edward;Gatsonis, Constantine A.
通讯作者：
Gatsonis, Constantine A.
DOI：
10.7326/0003-4819-137-5_part_1-200209030-00012
发表时间：
2002-09-03
影响因子：
39.2
作者：
Humphrey, LL;Helfand, M;Woolf, SH
通讯作者：
Woolf, SH