Authors: Adriana M J Bluekens Nico Karssemeijer David Beijerinck Jan J M Deurenberg Ruben E van Engen Mireille J M Broeders Gerard J den Heeten
Publish Date: 2010/04/21
Volume: 20, Issue: 9, Pages: 2067-2073
Abstract
Preceding the nationwide digitalisation of the Dutch screening programme an FFDM feasibility study was conducted Detection and referral rates for FFDM and screenfilm mammography SFM were compared for first and subsequent screens Furthermore radiological characteristics of referrals in digital screening were assessedA total of 312414 screening mammograms were performed 43913 digital and 268501 conventional with 4473 consecutive referrals 966 following FFDM Initially the FFDM referral rate peaked and many falsepositive 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 = 010As a result of initial inexperience with digital screening images implementing FFDM in a populationbased 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 detectionScreening mammography has been shown to be effective in reducing breast cancer mortality 1 2 Fullfield digital mammography FFDM is increasingly used in the clinical setting with a number of advantages resulting in better detection of early breast cancer and improvements in workflow 3Because of innovations fast technical developments and emerging evidence that FFDM as a screening test is at least as effective as conventional screenfilm mammography SFM the national coordinating team of the Dutch breast cancer screening decided to start digital pilot projects in 2003 Their main aim was to gain experience and to test the feasibility of digitalisation of the nationwide Dutch screening programmeMore recent studies concerning diagnostic accuracy confirmed that digital mammography as a screening technique in a populationbased screening programme is at least as accurate as SFM 4 5 6 7 8 9 10 11 In several studies an increase in referral rate following the implementation of FFDM has been reported 4 5 8 a tendency we also recognised in our previous study 11 Nevertheless this effect on referral rate has never been analysed in detail Since changes in referral rate directly affect the daily screening practice and workup understanding this increase in referral rate is of crucial importance and analysis could be useful to design a dedicated training programmeThe focus of this study as part of the Dutch digital pilot projects was to investigate the referral pattern after the introduction of digital mammography in the national screening programme We provide a comprehensive evaluation of the changes in referral rates over time reported separately for first and subsequent screening examinations compared with those in conventional mammography Additionally a detailed analysis of the radiographic characteristics of the referred lesions will be given
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