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25.06.2018 | Breast

Characteristics of screen-detected cancers following concordant or discordant recalls at blinded double reading in biennial digital screening mammography

verfasst von: Angela M. P. Coolen, Joost R. C. Lameijer, Adri C. Voogd, Marieke W. J. Louwman, Luc J. Strobbe, Vivianne C. G. Tjan-Heijnen, Lucien E. M. Duijm

Erschienen in: European Radiology | Ausgabe 1/2019

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Abstract

Objectives

To analyse which mammographic and tumour characteristics led to concordant versus discordant recalls at blinded double reading to further optimise our breast cancer screening programme.

Methods

We included a consecutive series of 99,013 screening mammograms obtained between July 2013 and January 2015. All mammograms were double read in a blinded fashion. Discordant readings were routinely recalled without consensus or arbitration. During the 2-year follow-up, relevant data of the recalled women were collected. We compared mammographic characteristics, screening outcome and tumour characteristics between concordant and discordant recalls.

Results

There were 2,543 concordant recalls (71.4%) and 997 discordant recalls (28.0%). The positive predictive value of a concordant recall was significantly higher (23.5% vs. 10.0%, p < 0.001). The proportion of BI-RADS 0 was significantly higher in the discordant recall group (75.7% vs. 56.3%, p < 0.001). Discordant recalls were more often an asymmetry or architectural distortion (21.8% vs. 13.2% and 9.3% vs. 6.5%, respectively, p < 0.001). There were no differences in the distribution of DCIS and invasive cancers and tumour characteristics were comparable for the two groups, except for a more favourable tumour grade in the discordant recall group (54.7% vs. 39.9% grade I tumours, p = 0.022).

Conclusions

Screen-detected cancers detected by a discordant reading show a more favourable tumour grade than cancers diagnosed after a concordant recall. The higher proportion of asymmetries and architectural distortions in this group provide a possible target for improving screening programmes by additional training of screening radiologists and the implementation of digital breast tomosynthesis.

Key Points

• With blinded double reading of screening mammograms, screen-detected cancers detected by a discordant reading show a more favourable tumour grade than cancers diagnosed after a concordant recall.

• The proportions of asymmetries and architectural distortions are higher in case of a discordant reading.

• Possible improvement strategies could target additional training of screening radiologists and the implementation of digital breast tomosynthesis in breast cancer screening programmes.

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Titel: Characteristics of screen-detected cancers following concordant or discordant recalls at blinded double reading in biennial digital screening mammography
verfasst von: Angela M. P. Coolen
Joost R. C. Lameijer
Adri C. Voogd
Marieke W. J. Louwman
Luc J. Strobbe
Vivianne C. G. Tjan-Heijnen
Lucien E. M. Duijm
Publikationsdatum: 25.06.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 1/2019
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-018-5586-9

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Characteristics of screen-detected cancers following concordant or discordant recalls at blinded double reading in biennial digital screening mammography