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Consequences of digital mammography in population-based breast cancer screening: initial changes and long-term impact on referral rates.

Bluekens AM, Karssemeijer N, Beijerinck D, Deurenberg JJ, van Engen RE, Broeders MJ, den Heeten GJ - Eur Radiol (2010)

Bottom Line: Preceding the nationwide digitalisation of the Dutch screening programme, an FFDM feasibility study was conducted.Detection and referral rates for FFDM and screen-film mammography (SFM) were compared for first and subsequent screens.Referral rates decrease and stabilise (learning curve effect) at a higher level than in conventional screening, yet with significantly enhanced cancer detection.

View Article: PubMed Central - PubMed

Affiliation: National Expert and Training Centre for Breast Cancer Screening, P.O. Box 6873, 6503 GJ, Nijmegen, The Netherlands. a.bluekens@lrcb.umcn.nl

ABSTRACT

Objectives: To investigate the referral pattern after the transition to full-field digital mammography (FFDM) in a population-based breast cancer screening programme.

Methods: Preceding the nationwide digitalisation of the Dutch screening programme, an FFDM feasibility study was conducted. Detection and referral rates for FFDM and screen-film mammography (SFM) were compared for first and subsequent screens. Furthermore, radiological characteristics of referrals in digital screening were assessed.

Results: A total of 312,414 screening mammograms were performed (43,913 digital and 268,501 conventional), with 4,473 consecutive referrals (966 following FFDM). Initially the FFDM referral rate peaked, and many false-positive results were noted as a consequence of pseudolesions and increased detection of (benign) microcalcifications. A higher overall referral rate was observed in FFDM screening in both first and subsequent examinations (p < .001), with a significant increase in cancer detection (p = .010).

Conclusion: As a result of initial inexperience with digital screening images implementing FFDM in a population-based breast cancer screening programme may lead to a strong, but temporary increase in referral. Dedicated training in digital screening for radiographers and screening radiologists is therefore recommended. Referral rates decrease and stabilise (learning curve effect) at a higher level than in conventional screening, yet with significantly enhanced cancer detection.

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Related in: MedlinePlus

Pseudolesion seen with high contrast resolution in FFDM. a Prior screening mammogram (SFM), b screening mammogram followed by referral (FFDM), c mammogram in subsequent clinical assessment (FFDM)
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Fig4: Pseudolesion seen with high contrast resolution in FFDM. a Prior screening mammogram (SFM), b screening mammogram followed by referral (FFDM), c mammogram in subsequent clinical assessment (FFDM)

Mentions: The introduction of FFDM in the screening programme initially caused a disproportionate increase in referral with subsequent false-positive results. Three reasons for this effect can be distinguished; all related to the use of post-processed high contrast images. First of all, high contrast resolution accentuates not only lesions, but normal architecture as well. Therefore, simulated lesions, or pseudolesions, could be more often encountered in FFDM (Fig. 4). Although true lesions should be better distinguishable, the reading and interpretation of digital high volume screening images is a learning process. This might explain the high referral rate caused by densities and distortions, accompanied by an increase in the number of false positives in the first months.Fig. 4


Consequences of digital mammography in population-based breast cancer screening: initial changes and long-term impact on referral rates.

Bluekens AM, Karssemeijer N, Beijerinck D, Deurenberg JJ, van Engen RE, Broeders MJ, den Heeten GJ - Eur Radiol (2010)

Pseudolesion seen with high contrast resolution in FFDM. a Prior screening mammogram (SFM), b screening mammogram followed by referral (FFDM), c mammogram in subsequent clinical assessment (FFDM)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2914257&req=5

Fig4: Pseudolesion seen with high contrast resolution in FFDM. a Prior screening mammogram (SFM), b screening mammogram followed by referral (FFDM), c mammogram in subsequent clinical assessment (FFDM)
Mentions: The introduction of FFDM in the screening programme initially caused a disproportionate increase in referral with subsequent false-positive results. Three reasons for this effect can be distinguished; all related to the use of post-processed high contrast images. First of all, high contrast resolution accentuates not only lesions, but normal architecture as well. Therefore, simulated lesions, or pseudolesions, could be more often encountered in FFDM (Fig. 4). Although true lesions should be better distinguishable, the reading and interpretation of digital high volume screening images is a learning process. This might explain the high referral rate caused by densities and distortions, accompanied by an increase in the number of false positives in the first months.Fig. 4

Bottom Line: Preceding the nationwide digitalisation of the Dutch screening programme, an FFDM feasibility study was conducted.Detection and referral rates for FFDM and screen-film mammography (SFM) were compared for first and subsequent screens.Referral rates decrease and stabilise (learning curve effect) at a higher level than in conventional screening, yet with significantly enhanced cancer detection.

View Article: PubMed Central - PubMed

Affiliation: National Expert and Training Centre for Breast Cancer Screening, P.O. Box 6873, 6503 GJ, Nijmegen, The Netherlands. a.bluekens@lrcb.umcn.nl

ABSTRACT

Objectives: To investigate the referral pattern after the transition to full-field digital mammography (FFDM) in a population-based breast cancer screening programme.

Methods: Preceding the nationwide digitalisation of the Dutch screening programme, an FFDM feasibility study was conducted. Detection and referral rates for FFDM and screen-film mammography (SFM) were compared for first and subsequent screens. Furthermore, radiological characteristics of referrals in digital screening were assessed.

Results: A total of 312,414 screening mammograms were performed (43,913 digital and 268,501 conventional), with 4,473 consecutive referrals (966 following FFDM). Initially the FFDM referral rate peaked, and many false-positive results were noted as a consequence of pseudolesions and increased detection of (benign) microcalcifications. A higher overall referral rate was observed in FFDM screening in both first and subsequent examinations (p < .001), with a significant increase in cancer detection (p = .010).

Conclusion: As a result of initial inexperience with digital screening images implementing FFDM in a population-based breast cancer screening programme may lead to a strong, but temporary increase in referral. Dedicated training in digital screening for radiographers and screening radiologists is therefore recommended. Referral rates decrease and stabilise (learning curve effect) at a higher level than in conventional screening, yet with significantly enhanced cancer detection.

Show MeSH
Related in: MedlinePlus