Abstract
Rapid expansion of the National Health Service Breast Screening Programme (NHSBSP) will result in many new readers undertaking the task of screen reading. A timely method for assessing performance (sensitivity and specificity), and preferably one that facilitates a steep learning curve, will be required. Since 1995, 90% of films have been double read at this unit. A manual record is kept of cancers detected through double reading and subsequent 3rd reader arbitration. The number of cases read and individuals' recall rates, when acting as the 1st reader, were obtained by running an annual co-writer report. A total of 150,344 women were screened between April 1995 and March 2001, resulting in the detection of 880 cancers. Sixty-six (7.5%) were detected following arbitration. There was variation both in recall to assessment rates and in the number of cases incorrectly returned to routine recall between readers. Prompt feedback of 'missed' cases allowed readers to modify their recall thresholds for particular mammographic abnormalities. If the cases had been single read the reader would have remained unaware of the 'miss' until the woman presented symptomatically with an interval cancer or the cancer was detected at the next screening round. It is recommended that the National Screening Committee review the policy of single versus double reading in the NHSBSP.
Highlights
Histological analysis of core biopsy of breast lesions takes a minimum of 24 h, but imprint cytology of a core biopsy can be reported within an hour
A total of 450,425 women were screened by BreastScreen Western Australia (BSWA) from January 1990 to December 2000. 2,314 cancers were detected with a total cancer detection rate of 5.1 cancers per 1,000 women screened. 4,916 women of ATSI origin were screened during this interval. 31 breast cancers were diagnosed, with a total cancer detection rate of 6.3 cancers per 1,000 women screened
These lesions may mimic the microcalcifications of ductal carcinoma in situ at screening mammography
Summary
Histological analysis of core biopsy of breast lesions takes a minimum of 24 h, but imprint cytology of a core biopsy can be reported within an hour. This study validates the accuracy of imprint cytology from core biopsy of breast lesions obtained under ultrasound control. Full field digital mammography (FFDM) seems set to replace conventional film-screen technique. Concern has been raised over FFDM diminished spatial resolution (5–6 Ip/mm). If valid, this could compromise detection of calcification and diagnosis of ductal carcinoma in situ (DCIS). In our centre we were not able to perceive any difference between microfocus magnification and on-screen magnification when assessing microcalcification. We subsequently compared these results with average scores for over 90 film-screen mammography systems
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