Accuracy Of Screening Mammography Research Articles

Patient-Awareness Survey: Do Breast Implants Affect the Acquisition and Accuracy of Screening Mammography?

Breast implant augmentation is the most common cosmetic surgical procedure performed in the United States. The purpose of this study was to determine if patients with breast augmentation surgery are aware of the effect of breast implants on the mammographic detection of cancer. An institutional review board exempt patient awareness survey was distributed at a single breast imaging facility to women undergoing screening mammography. Comparative statistical analyses were performed between patients with and without breast implants. The respondents were divided into three groups: no prior breast surgery (74%; 524/711), breast surgery with implants (21%; 152/711), and breast surgery without implants (5%; 35/711). Patients with breast implants were more aware that implants decrease the amount of breast tissue seen on a mammogram (75%; 105/141) and that implants result in the need for more mammogram views (70%; 103/147), as compared with patients with no surgery (46%; 221/484 and 31%; 147/478, respectively) (P < 0.001). More women with breast implants reported learning from breast imaging staff rather than from their surgeon that implants decrease the amount of breast tissue seen on a mammogram (46%; 49/106 vs. 38%; 40/106). Of 137 respondents, 35% (n = 48) reported that the effect of implants on their mammogram was discussed preoperatively. Of those who did not recall a preoperative discussion, 42% (16/38) indicated this knowledge would have factored into their decision to get breast implants. This study highlights an opportunity for providers to engage in more education and shared decision-making with patients considering breast augmentation surgery to ensure preoperative counseling includes discussion of the effect of implants on mammography.

Implementation of Performance Indicators in the Czech Breast Cancer Screening Programme – Results of the Regular Monitoring

The Czech organised breast cancer screening programme was initiated in 2002. Collection of data on screening mammography examinations, subsequent diagnostic procedures, and final dia-gnosis is an indispensable part of the programme. Data collection is obligatory for all accredited centres, in accordance with regulations issued by the Czech Ministry of Health. This contribution aims to demonstrate the recent results of quality monitoring of the accredited centres. Quality indicators, whose definition complies with international standards, involve the women's participation, the volume of performed examinations, the accuracy of screening mammography, the use of preoperative diagnostics, and the proportion of early detected tumours. Our evaluation documents a continuous improvement in quality of the Czech mammography screening programme, which is thereby in full agreement with international recommendations on quality assurance.

Accuracy of screening mammography in women with a history of lobular carcinoma in situ or atypical hyperplasia of the breast.

Women with lobular carcinoma in situ (LCIS), atypical lobular hyperplasia (ALH), atypical ductal hyperplasia (ADH), or atypical hyperplasia (AH) are at increased breast cancer (BC) risk. We investigated the accuracy and outcomes of mammography screening in women with histology-proven LCIS, ALH, ADH, or AH history who had screening through Breast Cancer Surveillance Consortium-affiliated mammography facilities. Screens from two cohorts, defined by LCIS/ALH or ADH/AH history, were compared to two cohorts without such history mammogram-matched for age-group, breast density, family history, screen-year, and mammography registry. Overall 359 BCs (277 invasive BC) occurred within 1 year from screening among 52,380 screens. In the LCIS/ALH cohort [versus comparator screens] cancer incidence rates, cancer detection rates (CDR), and interval cancer rates (ICR) were significantly higher (all P < 0.001); although ICR was 4.4/1,000 screens [versus 0.9/1,000; P < 0.001] the proportion that were interval cancers did not differ between compared cohorts (P = 0.43); screening sensitivity was 76.1 % [versus 82.3 %; P = 0.43], however, specificity was significantly lower at 85.1 % [versus 90.7 %; P < 0.0001]. In the ADH/AH cohort [versus comparator] cancer rates and CDR were significantly higher (P < 0.001); although ICR was 2.6/1,000 screens [versus 0.9/1,000; P = 0.002] the proportion that were interval cancers did not differ between cohorts (P = 0.74); screening sensitivity was 81.0 % [versus 82.6 %; P = 0.74] and specificity was lower at 86.2 % [versus 90.2 %; P < 0.0001]. Mammography screening sensitivity in LCIS/ALH and ADH/AH cohorts did not significantly differ from that of matched screens, however, specificity was lower, and ICRs were higher (reflecting underlying cancer rates). Adjunct screening may be of value in these women if it reduces ICR without substantially reducing specificity.

Contrast enhanced mammography: Techniques, current results, and potential indications

The application of x-rays for breast imaging followed some 18 years after the discovery of x-rays by Conrad Wilhelm Röntgen, 1 Pisano E.D. Gatsonis C. Hendrick E. et al. Diagnostic performance of digital versus film mammography for breast cancer screening. N Eng J Med. 2005; 353: 1773-1783 Crossref PubMed Scopus (1540) Google Scholar followed by several generations of technical improvements. Significant improvements in mammography were made around the turn of the millennium, when digital mammography systems were introduced. Although the diagnostic accuracy of digital full-field mammography is, in general, considered good, it is still dependent on breast density. 1 Pisano E.D. Gatsonis C. Hendrick E. et al. Diagnostic performance of digital versus film mammography for breast cancer screening. N Eng J Med. 2005; 353: 1773-1783 Crossref PubMed Scopus (1540) Google Scholar , 2 Carney P.A. Miglioretti D.L. Yankaskas B.C. et al. Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Ann Intern Med. 2003; 138: 168-175 Crossref PubMed Scopus (897) Google Scholar Carney et al. 2 Carney P.A. Miglioretti D.L. Yankaskas B.C. et al. Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Ann Intern Med. 2003; 138: 168-175 Crossref PubMed Scopus (897) Google Scholar showed that sensitivity of screening mammography in women with extremely dense breasts was 62.9%, versus 87% in women with fatty involution. Specificity was 89.1% in women with extremely dense breasts, versus 96.9% in women with fatty involution. 2 Carney P.A. Miglioretti D.L. Yankaskas B.C. et al. Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Ann Intern Med. 2003; 138: 168-175 Crossref PubMed Scopus (897) Google Scholar

Association Between Time Spent Interpreting, Level of Confidence, and Accuracy of Screening Mammography

The objective of this study was to examine the effect of time spent viewing images and level of confidence on a screening mammography test set on interpretive performance. Radiologists from six mammography registries participated in this study and were randomized to interpret one of four test sets and complete 12 survey questions. Each test set had 109 cases of digitized four-view screening screen-film mammograms with prior comparison screening views. Viewing time for each case was defined as the cumulative time spent viewing all mammographic images before recording which visible feature, if any, was the "most significant finding." Log-linear regression fit via the generalized estimating equation was used to test the effect of viewing time and level of confidence in the interpretation on test set sensitivity and false-positive rate. One hundred nineteen radiologists completed a test set and contributed data on 11,484 interpretations. The radiologists spent more time viewing cases that had significant findings or cases for which they had less confidence in their interpretation. Each additional minute of viewing time increased the probability of a true-positive interpretation among cancer cases by 1.12 (95% CI, 1.06-1.19; p < 0.001) regardless of confidence in the assessment. Among the radiologists who were very confident in their assessment, each additional minute of viewing time increased the adjusted risk of a false-positive interpretation among noncancer cases by 1.42 (95% CI, 1.21-1.68), and this viewing-time effect diminished with decreasing confidence. Longer interpretation times and higher levels of confidence in an interpretation are both associated with higher sensitivity and false-positive rates in mammography screening.

Association Between Time Spent Interpreting, Level of Confidence, and Accuracy of Screening Mammography

Association Between Time Spent Interpreting, Level of Confidence, and Accuracy of Screening Mammography

Accuracy of Screening Mammography in Older Women

Accuracy of Screening Mammography in Older Women

Accuracy of Screening Mammography in Older Women

The objective of our study was to determine the accuracy and cancer detection rate of screening mammography in women as they age. Using data from the Vermont Breast Cancer Surveillance System (1996-2006), we calculated the sensitivity, specificity, positive predictive value, negative predictive value, and cancer detection rate by decade of age for 403,448 mammograms of 96,193 women 50-101 years old. Confounding variables were assessed using logistic regression analysis. The sensitivity of screening mammography increased from 77.3% for the 50- to 59-year-old group to 93.8% for the 90- to 101-year-old group (p = 0.015). Specificity increased from 98.7% to 98.8% at age 50-59 compared with age 90-101 (p < 0.001), respectively. The cancer detection rate increased from 3.7 cases per 1000 mammograms at age 50-59 to 14.4 cases per 1000 mammograms at age 90-101 (p < 0.001). The prevalence of breast cancer increased from 4.8% to 15.4% across age groups (p < 0.001) as did the positive predictive value from 22.2% to 55.6% (p <0.001). There was no evidence of confounding by body mass index, breast density, or other factors. Tumors were more likely to be small, hormone receptor-positive, and more invasive as women aged. Accuracy parameters were all associated with age without evidence of confounding by regression analysis. Screening mammography is more accurate in older women than in younger women, suggesting that it may be of value in assessing women in all age groups. These data do not address the impact of mammography screening on mortality or breast cancer outcomes.

Abstract P2-01-02: The Incidence of Mammographically-Occult Breast Cancer in Women Older than Seventy Years

Abstract Background: Mammographic density generally decreases over time, which increases the sensitivity of screening mammography. However a significant proportion of older women have persistently dense breast tissue. This raises the question of how best to screen older women, particularly those with mammographically dense tissue or other risk factors. Little information exists about the accuracy of screening mammography in women older than seventy years. Additionally, the frequency of older women with mammographically-occult breast cancer is also unknown. The purpose of this study was to report the incidence of mammographicallyoccult breast cancer in women older than seventy and to describe the clinical factors that may be associated with this presentation. Methods: A retrospective chart review was conducted of women older than seventy diagnosed with breast cancer (intraductal carcinoma, invasive ductal carcinoma and invasive lobular carcinoma) at NYU Langone Medical Center from 2002-2009. Data collected included age, presentation, stage, mammographic density, BI-RADS results, breast ultrasound (US) and MRI results, and risk factors. Breast density was categorized according to BI-RADS definitions: 1. predominantly fatty, 2. scattered fibroglandular elements, 3. heterogeneously dense, or 4. extremely dense. Descriptive analyses were applied. Results: A total of 401 women older than seventy years were diagnosed with breast cancer at our institution. A cohort of 20 (5%) had mammographically occult disease. The median age was 77 years (range 71 to 89 yrs). Of the 20 mammographically occult cases, the majority (75%) were detected as a palpable mass, one was detected by screening US and four were detected by screening MRI. The majority of the cohort (65%) had been screened regularly with mammography prior to diagnosis. When we examined mammographic density, 60% had heterogeneously dense or extremely dense tissue. Nineteen out of twenty were diagnosed with early stage disease. There were 4 cases of DCIS, 10 (50%) were stage 1, and 5 (25%) were stage 2. Seven (35%) had invasive lobular carcinoma on final histopathology. Nine (45%) patients also had an antecedent history of breast cancer; 4 had ipsilateral recurrences and 5 had contralateral new primaries. Only 4 (20%) had a history of HRT use and 7 (35%) had a family history of breast cancer. Discussion: A meaningful proportion of women older than age seventy diagnosed with breast cancer at our institution had mammographicallyoccult disease. A majority (60%) of these patients had heterogeneously dense or extremely dense breast tissue, potentially limiting the sensitivity of mammographic screening in this cohort. In previous work, we evaluated a large number of screening mammograms and reported an incidence of 37% dense breast tissue in women of the same age group. This suggests that increased mammographic density, even in older women, may increase the potential for mammographically occult breast cancer. Particularly for women with increased risk based on a personal or family history of breast cancer, the addition of other imaging modalities may be of value in the presence of mammographically dense tissue regardless of patient age. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-01-02.

Influence of Hormone Replacement Therapy on the Accuracy of Screening Mammography

The use of hormone replacement therapy (HRT) is currently a subject of debate because of the possibility of an increase in the incidence of breast cancer and difficulties associated with breast cancer detection. The objective of this study was to determine the influence of HRT on specificity and sensitivity in a breast cancer screening program. We found that although specificity was significantly lower in menopausal women who had ever used or were currently using HRT (93.3%) compared to HRT nonusers (94.8%) at the expense of a greater number of recalls (6.9% versus 5.6%), this difference seems to be clinically irrelevant. There were no significant differences with regard to the number of invasive procedures (2.5% in the HRT versus 2.1% in the control group). We conclude that the slight decrease in sensitivity of screening mammography in HRT users is not clinically significant in our setting, and in any case, false positives (recalled women) are diagnosed correctly with additional imaging studies without the need for invasive procedures. Most women given HRT are candidates to participate in population breast cancer screening campaigns.

Physician Predictors of Mammographic Accuracy

The association between physician experience and the accuracy of screening mammography in community practice is not well studied. We identified characteristics of U.S. physicians associated with the accuracy of screening mammography. Data were obtained from the Breast Cancer Surveillance Consortium and the American Medical Association Master File. Unadjusted mammography sensitivity and specificity were calculated according to physician characteristics. We modeled mammography sensitivity and specificity by multivariable logistic regression as a function of patient and physician characteristics. All statistical tests were two-sided. We studied 209 physicians who interpreted 1,220,046 screening mammograms from January 1, 1995, through December 31, 2000, of which 7143 (5.9 per 1000 mammograms) were associated with breast cancer within 12 months of screening. Each physician interpreted a mean of 6011 screening mammograms (95% confidence interval [CI] = 4998 to 6677), including a mean of 34 (95% CI = 28 to 40) from women diagnosed with breast cancer. The mean sensitivity was 77% (range = 29%-97%), and the mean false-positive rate was 10% (range = 1%-29%). After adjustment for the patient characteristics of those whose mammograms they interpreted, physician characteristics were strongly associated with specificity. Higher specificity was associated with at least 25 years (versus less than 10 years) since receipt of a medical degree (for physicians practicing for 25-29 years, odds ratio [OR] = 1.54, 95% CI = 1.14 to 2.08; P = .006), interpretation of 2500-4000 (versus 481-750) screening mammograms annually (OR = 1.30, 95% CI = 1.06 to 1.59; P = .011) and a high focus on screening mammography compared with diagnostic mammography (OR = 1.59, 95% CI = 1.37 to 1.82; P<.001). Higher overall accuracy was associated with more experience and with a higher focus on screening mammography. Compared with physicians who interpret 481-750 mammograms annually and had a low screening focus, physicians who interpret 2500-4000 mammograms annually and had a high screening focus had approximately 50% fewer false-positive examinations and detected a few less cancers. Raising the annual volume requirements in the Mammography Quality Standards Act might improve the overall quality of screening mammography in the United States.

Correction: Factors That Affect Accuracy of Screening Mammography

Correction: Factors That Affect Accuracy of Screening Mammography

Accuracy of Screening Mammography Using Single Versus Independent Double Interpretation

We conducted an analysis among 31 community radiologists to identify the average change in screening mammography interpretive accuracy afforded by independent double interpretation. We assessed interpretive accuracy using a stratified random sample of test mammograms that included 30 women with cancer and 83 without. Radiologists were unaware of clinical information and of each other's assessments. We describe accuracy for individual radiologists and for double interpretation, including average sensitivity, specificity, diagnostic likelihood ratios positive and negative, and area under the receiver operating characteristic (ROC) curve. We also assessed weighted and nonweighted kappa statistics among all 465 pairs of radiologists and 31,465 pairs of unique pairs. The assessment for double interpretations used the "highest" (i.e., most abnormal) assessment of the two radiologists. We calculated the difference between each radiologist's individual accuracy and the average accuracy across that radiologist's 30 double interpretations. We found the following average accuracy statistics for individual radiologists: sensitivity, 79%; specificity, 81%; diagnostic likelihood ratio positive, 5.53; diagnostic likelihood ratio negative, 0.26; and area under the ROC curve, 0.85. The mean kappa statistic among radiologists for cancer cases increased with double interpretation from 0.59 to 0.70, and for noncancer cases from 0.30 to 0.34. Double interpretation resulted in an average increase in sensitivity of 7%, an average decrease in specificity of 11%, a decrease in diagnostic likelihood ratio positive of 2.35, a decrease in diagnostic likelihood ratio negative of 0.06, and an increase in area under the ROC curve of 0.02. Independent double interpretation does not increase accuracy as measured by the area under the ROC curve.

Age-related accuracy of screening mammography: how should it be measured?

Age-related accuracy of screening mammography: how should it be measured?

Interpretations of Mammograms Vary Widely

The accuracy of screening mammography depends not only on technical aspects of imaging, but also on interpretation of the results and the clinical recommendations that follow. This study from Yale found much variability in the …

Mammographically Detected Breast Cancer

Background. Needle-guided breast biopsy has become a regularly recommended procedure to excise non-palpable, questionable breast lesions detected by mammography. Whether cancers detected in this manner have a more favorable outcome than those detected by clinical examination is not clearly documented. Methods. To address questions about the biology of mammographically detected cancer and likelihood of axillary node metastasis, as well as the accuracy of screening mammography, data from 3752 needle-guided breast biopsies and 1175 nonpalpable breast cancers were reviewed. Results. Between 1974 and 1992, 3752 needle-guided biopsies were performed in 3441 women for nonpalpable breast lesions. Benign disease was disclosed in 2575 (68.7%) biopsies and malignancy in 1175 (31.3%). Of 1130 malignancies, 61.8% were invasive carcinomas; 4.8% were microinvasive ductal carcinomas; 28.5% were ductal carcinomas in situ; and 4.8% were lobular carcinomas in situ. Axillary dissection in 558 patients with invasive carcinoma revealed that 27.1% had at least one positive axillary node. Of patients with invasive cancers presenting as nonpalpable calcifications alone, 27.5% had at least one positive axillary node. Conclusions. More than one fourth of patients with nonpalpable, invasive cancer in this series had axillary node metastasis. Therefore, axillary dissection is an important treatment consideration for all patients with invasive carcinoma, despite technique of detection. Ductal carcinomas in situ detected as limited calcifications do not require axillary dissection. In this study, 31% of biopsies proved the presence of malignancy, an acceptable and appropriate benign-to-malignant ratio.

Mammographically detected breast cancer. Nonpalpable is not a synonym for inconsequential

Needle-guided breast biopsy has become a regularly recommended procedure to excise nonpalpable, questionable breast lesions detected by mammography. Whether cancers detected in this manner have a more favorable outcome than those detected by clinical examination is not clearly documented. To address questions about the biology of mammographically detected cancer and likelihood of axillary node metastasis, as well as the accuracy of screening mammography, data from 3752 needle-guided breast biopsies and 1175 nonpalpable breast cancers were reviewed. Between 1974 and 1992, 3752 needle-guided biopsies were performed in 3441 women for nonpalpable breast lesions. Benign disease was disclosed in 2575 (68.7%) biopsies and malignancy in 1175 (31.3%). Of 1130 malignancies, 61.8% were invasive carcinomas; 4.8% were microinvasive ductal carcinomas; 28.5% were ductal carcinomas in situ; and 4.8% were lobular carcinomas in situ. Axillary dissection in 558 patients with invasive carcinoma revealed that 27.1% had at least one positive axillary node. Of patients with invasive cancers presenting as nonpalpable calcifications alone, 27.5% had at least one positive axillary node. More than one fourth of patients with nonpalpable, invasive cancer in this series had axillary node metastasis. Therefore, axillary dissection is an important treatment consideration for all patients with invasive carcinoma, despite technique of detection. Ductal carcinomas in situ detected as limited calcifications do not require axillary dissection. In this study, 31% of biopsies proved the presence of malignancy, an acceptable and appropriate benign-to-malignant ratio.