Isabelle Théberge1,2, Nathalie Vandal3, Linda Perron3,4,5, Marie-Hélène Guertin3. 1. Institut national de santé publique du Québec, 945, Av. Wolfe, Quebec City, G1V 5B3, Canada. Isabelle.theberge@inspq.qc.ca. 2. Département de médecine sociale et préventive, Faculté de Médecine, Université Laval, Quebec City, Canada. Isabelle.theberge@inspq.qc.ca. 3. Institut national de santé publique du Québec, 945, Av. Wolfe, Quebec City, G1V 5B3, Canada. 4. Département de médecine sociale et préventive, Faculté de Médecine, Université Laval, Quebec City, Canada. 5. Département de santé publique et médecine préventive, CHU de Québec-Université Laval, Hôpital Saint-François d'Assise, Quebec City, Canada.
Abstract
PURPOSE: The aim of our study was, first, to measure association between radiologists and facilities characteristics and DCIS detection. Second, to assess whether those characteristics affect differently the likelihood of detection of DCIS versus invasive breast cancer. When applicable, we examined whether the identified characteristics were similarly associated with low-grade and high-grade DCIS detection. METHODS: This retrospective cohort study included 1,750,002 digital screening mammograms (2145 screen-detected DCIS) performed in the Quebec breast cancer screening program between 2007 and 2015 inclusively. The associations between radiologists' and facilities' characteristics and (1) the DCIS detection rate, (2) the invasive detection rate, and (3) the odds of DCIS on invasive detection were assess. For statistically significant associations in the latter analysis, analyses stratified by DCIS grade were performed. Multivariable logistic regression with generalized estimating equations estimates to account for correlation among mammograms was used. RESULTS: Compared to radiologists with recall rate between 5.0 and 9.9%, radiologists with recall rate between 15.0-19.9% and ≥ 20% reached a higher DCIS detection rate, with adjusted detection ratios of, respectively, 1.33 (95% confidence interval = 1.15-1.53) and 1.43 (95% confidence interval = 1.13-1.81). Increase in radiologist' recall rate was statistically significantly associated with an increase in detection of low/intermediate-grade DCIS (P < 0.001), while not in high-grade DCIS (P = 0.15). CONCLUSIONS: A major determinant of DCIS detection is the radiologists' recall rate. Abnormalities referred by radiologists with higher recall rates should be identified in order to understand how to decrease recall rate while keeping an optimal DCIS and invasive detection rate.
PURPOSE: The aim of our study was, first, to measure association between radiologists and facilities characteristics and DCIS detection. Second, to assess whether those characteristics affect differently the likelihood of detection of DCIS versus invasive breast cancer. When applicable, we examined whether the identified characteristics were similarly associated with low-grade and high-grade DCIS detection. METHODS: This retrospective cohort study included 1,750,002 digital screening mammograms (2145 screen-detected DCIS) performed in the Quebec breast cancer screening program between 2007 and 2015 inclusively. The associations between radiologists' and facilities' characteristics and (1) the DCIS detection rate, (2) the invasive detection rate, and (3) the odds of DCIS on invasive detection were assess. For statistically significant associations in the latter analysis, analyses stratified by DCIS grade were performed. Multivariable logistic regression with generalized estimating equations estimates to account for correlation among mammograms was used. RESULTS: Compared to radiologists with recall rate between 5.0 and 9.9%, radiologists with recall rate between 15.0-19.9% and ≥ 20% reached a higher DCIS detection rate, with adjusted detection ratios of, respectively, 1.33 (95% confidence interval = 1.15-1.53) and 1.43 (95% confidence interval = 1.13-1.81). Increase in radiologist' recall rate was statistically significantly associated with an increase in detection of low/intermediate-grade DCIS (P < 0.001), while not in high-grade DCIS (P = 0.15). CONCLUSIONS: A major determinant of DCIS detection is the radiologists' recall rate. Abnormalities referred by radiologists with higher recall rates should be identified in order to understand how to decrease recall rate while keeping an optimal DCIS and invasive detection rate.
Entities:
Keywords:
Breast cancer; Cancer detection rate; Ductal carcinoma in situ; Grade; Recall rate; Screening mammography
Authors: H Buerger; F Otterbach; R Simon; K L Schäfer; C Poremba; R Diallo; C Brinkschmidt; B Dockhorn-Dworniczak; W Boecker Journal: J Pathol Date: 1999-12 Impact factor: 7.996
Authors: Stefanie Weigel; Laura Khil; Hans-Werner Hense; Thomas Decker; Jürgen Wellmann; Jan Heidrich; Alexander Sommer; Oliver Heidinger; Walter Heindel Journal: Radiology Date: 2017-11-06 Impact factor: 11.105