Mammographic breast density: How it affects performance indicators in screening programmes?

Autor: Posso, M, Louro, J, Sanchez, M, Roman, M, Vidal, C, Sala, M, Bare, M, Castells, X, Buron, A, Domingo, L, Rodriguez-Arana, A, Servitja, S, Vernet, M, Benito, L, Quintana, MJ, Sola-Roca, J, Prieto, M, Galceran, J, Saladie, F, Ferrer, J, Espinas, JA, Penalva, L, Tora-Rocamora, I, Bargallo, X
Rok vydání: 2019
Předmět:
Zdroj: EUROPEAN JOURNAL OF RADIOLOGY
r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname
ISSN: 0720-048X
Popis: Objectives: To investigate how breast density affects screening performance indicators in a digital mammography context. Methods: We assessed the effect of breast density over the screen-detected and interval cancers rates, false-positives, specificity, sensitivity, recall rate, positive predictive value of recall (PPV-1), and PPV of invasive tests (PPV-2). Radiologists classified breast density using the BIRADS System. We used generalized estimating equations to account for within-woman correlation by means of the robust Huber-While variance estimator. Results: We included 177,164 women aged 50-69 years who underwent 499,251 digital mammograms from 2004 to 2015 in Spain. According to the fibroglandular tissue percentage, 24.7% of mammograms were classified as BI-RADS 1 ( < 25% glandular), 54.7% as BI-RADS 2 (25-50% glandular), 14.0% as BI-RADS 3 (51-75% glandular) and 6.6% as BI-RADS 4 ( > 75% glandular). Overall, women with BI-RADS 3 had the highest screen-detected cancer rate (5.9 per 1000) and BI-RADS 4 the highest interval cancer rate (2.4 per 1000). Sensitivity decreased from 89.2% in women with BI-RADS 1 to 67.9% in BI-RADS 4. Both PPV-1 and PPV-2 decreased from 10.4% to 5.7% and from 49.8% to 32.4% in women with BI-RADS 1 and BI-RADS 4, respectively. Women aged 60-69 years with BI-RADS 4 had the lowest sensitivity (54.9%) and the highest interval cancer rate (3.8 per 1000). Conclusions: Performance screening measures are negatively affected by breast density falling to a lower sensitivity and PPV, and higher interval cancer rate as breast density increases. Particularly women aged 60-69 years with > 75% glandular breasts had the worst results and therefore may be candidates for screening using other technologies.
Databáze: OpenAIRE
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