Breast Cancer: Missed Interval and Screening-detected Cancer at Full-Field Digital Mammography and Screen-Film Mammography-- Results from a Retrospective Review.

Source

Departments of Radiology and Oncology, Aalesund Hospital, Helse M?re og Romsdal HF, 6026 Aalesund, Norway; Department of Cancer Research and Molecular Medicine, National University for Science and Technology, Trondheim, Norway; Department of Radiology, Vestfold Hospital, T?nsberg, Norway; Department of Research, Cancer Registry of Norway, Oslo, Norway.

Abstract

Purpose:To compare the percentages and mammographic features of cancers missed at full-field digital mammography (FFDM) and screen-film mammography (SFM) in women who participated in the Norwegian Breast Cancer Screening Program in 2002-2008.Materials and Methods:Social Science Data Services approval was obtained; the requirement for informed consent was waived. Cases were all the interval and screening-detected cancers from 35 127 FFDM and 52 444 SFM examinations in two Norwegian counties. Prior and diagnostic FFDM examinations of 49 interval and 86 screening-detected breast cancers were reviewed by four breast radiologists and compared with a review of SFM examinations of 81 interval and 123 screening-detected cancers. Cancers were classified as missed or true, mammographic features were described, percentages were compared by using the ?(2) or Fisher exact test, and 95% confidence intervals (CIs) were calculated.Results:The percentages of interval and screening-detected cancers missed at FFDM and SFM did not differ significantly. (interval cancers missed: 33% [16 of 49] at FFDM vs 30% [24 of 81] at SFM [P = .868]; screening-detected cancers missed: 20% [17 of 86] at FFDM vs 21% [26 of 123] at SFM [P = .946]). Asymmetry was present in 27% (95% CI: 13.3%, 45.5%) of prior mammograms of cancers missed at FFDM and 10% (95% CI: 3.3%, 21.8%) of those missed at SFM (P = .070). Calcifications were observed in 18% (95% CI: 7.0%, 35.5%) of the cancers missed at FFDM and 34% (95% CI: 21.2%, 48.8%) of those missed at SFM (P = .185). Average mammographic tumor size of missed cancers manifesting as masses was 10.4 mm at FFDM and 13.6 mm at SFM (P = .036).Conclusion:The use of FFDM has not reduced the challenge of missed cancers. Cancers missed at FFDM tend to have different mammographic features than those missed at SFM.? RSNA, 2012.

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