Evaluatoin of False Positive Mammography in Community Practice

描述(申请人提供)：在美国的社区实践中，数据显示，大约90%的异常筛查乳房X光检查不会最终被诊断为癌症，或者是假阳性(FP)。该项目的长期目标是减少筛查乳房X光检查中的FP结果，同时减少额外的不必要的成像工作和不必要的活检的负担。我们的具体目标是：1)确定女性、乳房X光检查、放射科医生和做法的特征，区分FP和TP乳房X光检查；以及2)确定乳房X光检查异常的描述性特征，这些特征将提高区分FP和TP乳房X光检查结果的能力。这项研究将使用卡罗莱纳乳房X光检查登记处(CMR)的基础设施，这是一个基于人群的注册机构，收集北卡罗来纳州乳房X光检查机构中女性和乳房X光检查的前瞻性数据。CMR常规收集的可用于这项研究的数据包括女性的人口统计和健康史，以及在筛查工作中进行的影像研究的结果和建议。乳房X光摄影数据与北卡罗来纳州中央癌症登记中心和病理实验室的癌症结果数据相关联，提供筛查工作的结果数据。外部审查员将对CMR确定的阳性乳房X光照片进行积极审查，以标准化的方式对乳房X光检查结果进行分类。常规收集的CMR数据将与电影评论中的描述性数据相结合，以测试使用GEE Logistic分析从TP结果中区分FP的能力。此外，可能影响分析中使用的FP或TP预测的其他变量包括：乳房X光检查实践程序；放射科医生的特征；以及实践设置和类型。目标是提高识别假阳性结果的能力，最终降低召回率，增加阳性预测价值，而不降低癌症检测率。有可能减少女性在乳腺癌筛查中经历的额外成像研究和程序的工作，将在很大程度上有助于提高乳房X光检查的成本效益，无论是从女性的金钱、身体和心理成本，还是从医疗保健系统的经济成本来看。

DESCRIPTION (provided by applicant): In community practice in the U.S., data have shown that around 90% of abnormal screening mammograms do not end in a cancer diagnosis, or are false positive (FP). The long term goal of this project is to reduce FP results in screening mammography, both to reduce the burden of extra unnecessary imaging work-ups and unnecessary biopsies. Our specific aims are to: 1) identify the characteristics of women, mammographic examinations, radiologists and practices that discriminate a FP from a TP mammogram; and 2) identify the descriptive characteristics of abnormalities seen on mammograms that will improve the ability to discriminate a FP from TP mammography result when added to the findings of Aim 1. This study will use the infrastructure of the Carolina Mammography Registry (CMR), a population-based registry that collects prospective data on women and mammography examinations in mammography facilities in North Carolina. Data routinely collected by CMR that can be used for this study include demographic and health history on the women and the results and recommendations from imaging studies performed in the screening work-up. Mammography data are linked to cancer outcome data from the NC Central Cancer Registry and pathology laboratories, providing outcome data form the screening work-up. An active review of the films of positive mammograms identified from CMR will be conducted by outside reviewers, to classify the findings on the mammograms in a standardized way. The routinely collected CMR data will be combined with the descriptive data from the film review to test the ability to discriminate a FP from TP result, using GEE logistic analyses. In addition, other variables that could affect the prediction of a FP or TP that will be used in analyses include: mammography practice procedures; radiologist characteristics; and practice setting and type. The goal is to be improve the ability to identify false positive results, to ultimately reduce recall rates, increase positive predictive value, without a decrease in cancer detection rates. Work that has the potential to reduce the extra imaging studies and procedures that women experience in screening for breast cancer would go a long way toward making screening mammography more cost effective in terms of the monetary, physical and psychological costs to women, and the economic costs to the health care system.