Korean J Radiol.  2019 Dec;20(12):1638-1645. 10.3348/kjr.2019.0006.

Effect of Different Types of Mammography Equipment on Screening Outcomes: A Report by the Alliance for Breast Cancer Screening in Korea

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

• KMID: 2471676
• DOI: http://doi.org/10.3348/kjr.2019.0006

Abstract

OBJECTIVE
To investigate the effects of different types of mammography equipment on screening outcomes by comparing the performance of film-screen mammography (FSM), computed radiography mammography (CRM), and digital mammography (DM).
MATERIALS AND METHODS
We retrospectively enrolled 128756 sets of mammograms from 10 hospitals participating in the Alliance for Breast Cancer Screening in Korea between 2005 and 2010. We compared the diagnostic accuracy of the types of mammography equipment by analyzing the area under the receiver operating characteristic curve (AUC) with a 95% confidence interval (CI); performance indicators, including recall rate, cancer detection rate (CDR), positive predictive value₁ (PPV₁), sensitivity, specificity, and interval cancer rate (ICR); and the types of breast cancer pathology.
RESULTS
The AUCs were 0.898 (95% CI, 0.878-0.919) in DM, 0.860 (0.815-0.905) in FSM, and 0.866 (0.828-0.903) in CRM (p = 0.150). DM showed better performance than FSM and CRM in terms of the recall rate (14.8 vs. 24.8 and 19.8%), CDR (3.4 vs. 2.2 and 2.1 per 1000 examinations), PPV₁ (2.3 vs. 0.9 and 1.1%), and specificity (85.5 vs. 75.3 and 80.3%) (p < 0.001) but not in terms of sensitivity (86.3 vs. 87.4 and 86.3%) and ICR (0.6 vs. 0.4 and 0.4). The proportions of carcinoma in situ (CIS) were 27.5%, 13.6%, and 11.8% for DM, CRM, and FSM, respectively (p = 0.003).
CONCLUSION
In comparison to FSM and CRM, DM showed better performance in terms of the recall rate, CDR, PPV₁, and specificity, although the AUCs were similar, and more CISs were detected using DM. The application of DM may help to improve the quality of mammography screenings. However, the overdiagnosis issue of CIS using DM should be evaluated.

Keyword

Breast neoplasms; Digital mammography; Screening; Sensitivity and specificity

MeSH Terms

Area Under Curve
Breast Neoplasms*
Breast*
Carcinoma in Situ
Korea*
Mammography*
Mass Screening*
Medical Overuse
Pathology
Radiography
Retrospective Studies
ROC Curve
Sensitivity and Specificity

Figure

• 

  Fig. 1 Distribution of enrolled cases throughout study period by type of mammography equipment used in ABCS-K.ABCS-K = Alliance for Breast Cancer Screening in Korea, CRM = computed radiography mammography, DM = full-field digital mammography, FSM = film-screen mammography

• 

  Fig. 2 Distribution of enrolled cases by institution and type of mammography equipment used in ABCS-K.Total = total number of mammography cases enrolled according to institution

• 

  Fig. 3 Comparison of AUC for diagnostic accuracy according to type of mammography equipment used in ABCS-K.AUC = area under curve

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