Korean J Radiol.  2017 ;18(4):624-631. 10.3348/kjr.2017.18.4.624.

Analysis of Participant Factors That Affect the Diagnostic Performance of Screening Mammography: A Report of the Alliance for Breast Cancer Screening in Korea

• Kim YJ
• Lee EH
• Jun JK
• Shin DR
• Park YM
• Kim HW
• Kim Y
• Kim KW
• Lim HS
• Park JS
• Kim HJ
• Jo HM
• Alliance for Breast Cancer Screening in Korea (ABCS-K)

• KMID: 2427231
• DOI: http://doi.org/10.3348/kjr.2017.18.4.624

Abstract

OBJECTIVE
To analyze participant factors that affect the diagnostic performance of screening mammography.
MATERIALS AND METHODS
We enrolled 128756 cases from 10 hospitals between 2005 and 2010. We analyzed recall rate, cancer detection rate (CDR) per 1000 examinations, positive predictive value (PPV), sensitivity, specificity, false positive rate (FPR), and interval cancer rate (ICR) per 1000 negative examinations according to participant factors including age, breast density, and number of visit to the same institution, and adjusted for confounding variables.
RESULTS
Increasing age improved recall rates (27.4% in 40's, 17.5% in 50's, 11.1% in 60's, and 8.6% in 70's), CDR (2.7, 3.2, 2.0, and 2.4), PPV (1.0, 1.8, 1.8, and 2.8%), sensitivity (81.3, 88.8, 90.3, and 94.7%), specificity (72.7, 82.7, 89.0, and 91.7%), and FPR (27.3, 17.3, 11.0, and 8.4%) (p < 0.05). Higher breast density impaired recall rates (4.0% in P1, 9.0% in P2, 28.9% in P3, and 27.8% in P4), PPV (3.3, 2.3, 1.2, and 1.3%), specificity (96.1, 91.2, 71.4, and 72.5%), and FPR (3.9, 8.9, 28.6, and 27.6%) (p < 0.001). It also increased CDR (1.3, 2.1, 3.3, and 3.6) and ICR (0.2, 0.3, 0.6, and 1.6) (p < 0.05). Successive visits to the same institution improved recall rates (20.9% for one visit, 10.7% for two visits, 7.7% for more than three visits), PPV (1.6, 2.8, and 2.7%), specificity (79.4, 89.6, and 92.5%), and FPR (20.6, 10.4, and 7.5%) (p < 0.001).
CONCLUSION
Young age and dense breasts negatively affected diagnostic performance in mammography screening, whereas successive visits to the same institution had a positive effect. Examinee education for successive visits to the same institution would improve the diagnostic performance.

Keyword

Screening mammography; Cancer detection rates; Audit; National mammography database

MeSH Terms

Adult
Aged
Breast Density
Breast Neoplasms/*diagnosis/diagnostic imaging
Databases, Factual
Early Detection of Cancer
Female
Humans
Mammography
Middle Aged
Republic of Korea
Sensitivity and Specificity

Figure

• 

  Fig. 1 Final breast density classifications by age groups.Following BI-RADS criteria, breast density was classified as P1, almost entirely fatty; P2, scattered fibroglandular density; P3, heterogeneously dense; P4, extremely dense. BI-RADS = Breast Imaging-Reporting and Data System

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