Abstract

A study may only be feasible when routinely collected data (RCD) are used to identify participants. RCD from one centre in a retrospective study of computer-aided detection (CAD) in breast screening are considered. Double-read mammograms were re-read by a different reader using CAD (R2 ImageChecker®) and the cancer detection and recall rates were compared. Subjects attended routine screening during 1996 and were aged 50 years or over. Among RCD subjects, 11,947 (92.5%) were eligible. From the study sample (n = 5037), a subsample of 650 (13%) subjects was examined. Previous attendance was incorrect in all four subjects with earlier screening at a different centre. The reader was correctly recorded in all but one subject where it was missing on the paper copy. Whether a subject was recalled for further examination was correct for all subjects; however, single-reader recall, when recall was requested by only one radiologist, was incorrect in 22 (3%) cases; each was among the 53 (8%) recalls showing 42% were incorrect (95% confidence interval, 28–56%). Single-reader recall was unreliable and previous attendance did not have sufficient detail to report the whether a screen was prevalent. Both were checked throughout the study. Issues raised when using RCD are discussed.

Highlights

  • Neoplastic tissue contains elevated levels of choline-containing metabolites [1,2]

  • We examined the extent to which the lower mammographic sensitivity found in hormone replacement therapy (HRT) users could be explained by any association of HRT use with higher density and more difficult to detect cancers

  • The results suggest that applying compression does not ensure breast thickness reduction and observing physical changes does not guarantee that breast thickness has been minimised

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Summary

Introduction

Neoplastic tissue contains elevated levels of choline-containing metabolites (tCho) [1,2]. The presence of spiculation arising from a mass detected at mammography makes malignancy a probable diagnosis This is confirmed by this review of the first 8 years of screening in East Sussex where only 3.6% of masses with spiculation were benign at excision (24 out of 668), compared with 33.3% of masses without spiculation (102 out of 306). When breast core biopsy reveals lobular neoplasia (lobular carcinoma in situ [LCIS] or atypical lobular hyperplasia [ALH]) a management dilemma follows, as uncertainty regarding the significance of LCIS/ALH exists. Is this an indicator of increased risk of breast cancer or should it be considered a marker for more serious local pathology? Is this an indicator of increased risk of breast cancer or should it be considered a marker for more serious local pathology? Should surgical excision be undertaken in these cases?

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