Audit of Prior Screening Mammograms of Screen-Detected Cancers: Implications for the Delay in Breast Cancer Detection

IF 1.5 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Seminars in Ultrasound Ct and Mri Pub Date : 2023-02-01 DOI:10.1053/j.sult.2022.12.003

Gopal R. Vijayargahavan , Jade Watkins , Monique Tyminski , Shambhavi Venkataraman , Nita Amornsiripanitch , Adrienne Newburg , Erica Ghosh , Srinivasan Vedantham

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Abstract

When cancer is detected in a screening mammogram, on occasion retrospective review of prior screening (pre-index) mammograms indicates a likely presence of cancer. These missed cancers during pre-index screens constitute a delay in detection and diagnosis. This study was undertaken to quantify the missed cancer rate by auditing pre-index screens to improve the quality of mammography screening practice. From a cohort of 135 screen-detected cancers, 120 pre-index screening mammograms could be retrieved and served as the study sample. A consensus read by 2 radiologists who interpreted the pre-index screens in an unblinded manner with full knowledge of cancer location, cancer type, lesion type, and pathology served as the truth or reference standard. Five radiologists interpreted the pre-index screens in a blinded manner. Established performance metrics such as sensitivity and specificity were quantified for each reader in interpreting these pre-index screens in a blinded manner. All five radiologists detected lesions in 8/120 (6.7%) screens. Excluding the 2 readers whose performance was close to random, all the 3 remaining readers detected lesions in 13 pre-index screens. This indicates that there is a delay in diagnosis by at least one cycle from 8/120 (6.7%) to 13/120 (10.8%). There were no observable trends in terms of either the cancer type or the lesion type. Auditing prior screening mammograms in screen-detected cancers can help in identifying the proportion of cases that were missed during interpretation and help in quantifying the delay in breast cancer detection.

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乳腺癌筛查前乳腺钼靶检查：对乳腺癌症检测延迟的影响

当在筛查乳房X光检查中检测到癌症时，有时对先前筛查（预指数）乳房X光照片的回顾性审查表明可能存在癌症。这些在指数前筛查中遗漏的癌症构成了检测和诊断的延迟。这项研究旨在通过审计指标前筛查来量化癌症漏诊率，以提高乳腺X线筛查实践的质量。从135例筛查发现的癌症队列中，可以检索到120例指数前筛查的乳房X光照片，并将其作为研究样本。2名放射科医生在充分了解癌症位置、癌症类型、病变类型和病理学的情况下，以非盲方式解释索引前筛查的共识作为真相或参考标准。五名放射科医生以盲法解释索引前筛查。在以盲法解释这些索引前筛选时，对每个读者的既定绩效指标（如敏感性和特异性）进行了量化。所有五名放射科医生均在8/120（6.7%）的筛查中发现病变。除2名表现接近随机的读者外，其余3名读者在13个索引前屏幕中均检测到病变。这表明诊断延迟了至少一个周期，从8/120（6.7%）到13/120（10.8%）。无论是癌症类型还是病变类型，都没有明显的趋势。在筛查出的癌症中，审核先前的筛查乳房X光片可以帮助确定在解读过程中遗漏的病例比例，并有助于量化癌症检测的延迟。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Seminars in Ultrasound Ct and Mri 医学-核医学

CiteScore

2.60

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Seminars in Ultrasound, CT and MRI is directed to all physicians involved in the performance and interpretation of ultrasound, computed tomography, and magnetic resonance imaging procedures. It is a timely source for the publication of new concepts and research findings directly applicable to day-to-day clinical practice. The articles describe the performance of various procedures together with the authors'' approach to problems of interpretation.