Evaluatoin of False Positive Mammography in Community Practice

描述（由申请人提供）：在美国的社区实践中，数据显示，大约90%的异常筛查乳房x线照片没有最终诊断为癌症，或者是假阳性（FP）。该项目的长期目标是减少筛查乳房x光检查的FP结果，从而减少不必要的额外成像检查和不必要的活检的负担。我们的具体目标是：1)确定女性的特征、乳房x光检查、放射科医生和区分FP和TP乳房x光检查的做法；2)确定乳房x线照片上所见异常的描述性特征，当与目的1的结果相结合时，将提高区分FP和TP乳房x线照片结果的能力。本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登记处，收集北卡罗来纳州乳房x光检查设施中妇女和乳房x光检查的前瞻性数据。CMR常规收集的可用于本研究的数据包括妇女的人口统计学和健康史以及筛查工作中进行的影像学研究的结果和建议。乳房x光检查数据与NC中央癌症登记处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光片进行积极的审查，以标准化的方式对乳房x光片上的发现进行分类。常规收集的CMR数据将与来自电影评论的描述性数据相结合，使用GEE逻辑分析来测试区分FP和TP结果的能力。此外，其他可能影响FP或TP预测的变量包括：乳房x线摄影实践程序；放射科医生特征;练习排版和排版。目标是提高识别假阳性结果的能力，最终降低召回率，提高阳性预测值，同时不降低癌症检出率。这项工作有可能减少女性在乳腺癌筛查过程中所经历的额外成像研究和程序，这将大大有助于使乳房x光筛查更具成本效益，无论是从金钱、生理和心理成本方面，还是从医疗保健系统的经济成本方面。

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.