ABSTRACT
Objetivo. Valorar si la introducción de la mamografía digital (MD) en el cribado del cáncer de mama ha supuesto cambios en cuanto a la detección y manejo de las microcalcificaciones. Material y métodos. Se ha realizado un estudio retrospectivo de los indicadores de rendimiento de un programa de cribado del cáncer de mama que se relacionan con el diagnóstico de microcalcificaciones (tasas de recitación y de recomendación de controles intermedios después del cribado, tasa de indicación de procedimientos invasivos por microcalcificaciones, y su valor predictivo positivo, tasa de detección por microcalcificaciones y número de carcinomas ductales in situ [CDIS] diagnosticados). Se han comparado los resultados obtenidos con la mamografía digital directa (septiembre 2008-agosto 2009) frente a la mamografía analógica (septiembre 2006-agosto 2007). Para el análisis estadístico se utilizaron la Prueba de X2 y medidas de asociación. Resultados. Con MD se ha observado un aumento significativo de las tasas de recitación (de 50,8 a 64), de realización de controles intermedios (de 9,41 a 18,7), de indicación de pruebas invasivas (de 1,88 a 3,01), de cánceres detectados por microcalcificaciones (de 0,86 a 1,36) y del número de CDIS. Conclusión. La MD directa ha mejorado la detección de microcalcificaciones incrementando el número de CDIS diagnosticados, sin disminuir el valor predictivo positivo de los procedimientos invasivos indicados por microcalcificaciones. Sin embargo, ha tenido un efecto negativo por el aumento en la tasa de recitación y de indicación de seguimiento a corto plazo, posiblemente debido a la dificultad de comparación con estudios analógicos anteriores(AU)
Objective. To determine whether the introduction of digital mammography in breast cancer screening has resulted in changes in the detection and management of microcalcifications. Material and methods. We retrospectively studied the performance indicators of our breast cancer screening program that are related to the diagnosis of microcalcifications (rates of recall and recommendation of intermediate follow-up after screening, rate of indication of invasive procedures for microcalcifications and their positive predictive value, detection rate for microcalcifications, and number of ductal carcinomas in situ (DCIS) diagnosed). We compared the results obtained using direct digital mammography (september 2008-august 2009) with those obtained using analog mammography (september 2006-august 2007). Statistical analysis. Chi-square test and measures of association. Results. We found that using digital mammography led to significant increases in the recall rate (from 50.8 to 64), in the rate of intermediate follow-up after screening (from 9.41 to 18.7), in the rate of indication for invasive procedures (from 1.88 to 3.01), in the cancers detected through microcalcifications (from 0.86 to 1.36), and in the number of DCIS diagnosed. Conclusion. Direct digital mammography has improved the detection of microcalcifications, increasing the number of DCIS diagnosed without decreasing the positive predictive value of the invasive procedures indicated for microcalcifications. However, direct digital mammography has had a negative effect by increasing the recall rate and indication for short-term follow-up, possibly due to the difficulty of comparing the findings with those of earlier analog mammograms(AU)
Subject(s)
Humans , Male , Female , Calcinosis , Mammography , Ultrasonography, Mammary/instrumentation , Ultrasonography, Mammary/methods , Ultrasonography, Mammary , Breast Neoplasms , Early Diagnosis , Retrospective Studies , Mass Screening/methods , Predictive Value of TestsABSTRACT
OBJECTIVE: To determine whether the introduction of digital mammography in breast cancer screening has resulted in changes in the detection and management of microcalcifications. MATERIAL AND METHODS: We retrospectively studied the performance indicators of our breast cancer screening program that are related to the diagnosis of microcalcifications (rates of recall and recommendation of intermediate follow-up after screening, rate of indication of invasive procedures for microcalcifications and their positive predictive value, detection rate for microcalcifications, and number of ductal carcinomas in situ (DCIS) diagnosed). We compared the results obtained using direct digital mammography (september 2008-august 2009) with those obtained using analog mammography (September 2006-August 2007). STATISTICAL ANALYSIS: Chi-square test and measures of association. RESULTS: We found that using digital mammography led to significant increases in the recall rate (from 50.8 to 64), in the rate of intermediate follow-up after screening (from 9.41 to 18.7), in the rate of indication for invasive procedures (from 1.88 to 3.01), in the cancers detected through microcalcifications (from 0.86 to 1.36), and in the number of DCIS diagnosed. CONCLUSION: Direct digital mammography has improved the detection of microcalcifications, increasing the number of DCIS diagnosed without decreasing the positive predictive value of the invasive procedures indicated for microcalcifications. However, direct digital mammography has had a negative effect by increasing the recall rate and indication for short-term follow-up, possibly due to the difficulty of comparing the findings with those of earlier analog mammograms.
Subject(s)
Breast Diseases/diagnostic imaging , Breast Neoplasms/diagnostic imaging , Calcinosis/diagnostic imaging , Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging , Early Detection of Cancer , Mammography/methods , Radiographic Image Enhancement , Breast Diseases/therapy , Breast Neoplasms/complications , Calcinosis/complications , Calcinosis/therapy , Carcinoma, Intraductal, Noninfiltrating/complications , Female , Humans , Retrospective StudiesABSTRACT
Fundamento. Existe un consenso general en la recomendación de aplicar con carácter poblacional programas de cribado de cáncer de mama. El Departamento de Salud puso en marcha en el año 1990 un Programa de Detección Precoz de Cáncer de Mama, con el objetivo de disminuir la mortalidad por este tumor, que en este momento está finalizando su séptima vuelta. El presente trabajo tiene como objetivo analizar los resultados obtenidos, describiendo los principales indicadores de proceso y predictores de impacto según los factores más determinantes. Material y métodos. Se han recopilado los datos de las exploraciones de cribado realizadas desde el comienzo del programa hasta el 31 de diciembre de 2002 clasificando por edad en el momento de la exploración, tipo de exploración y vuelta. Resultados. Durante el período se han realizado 354.575 exploraciones. Indicadores de proceso: en el 11,22 por ciento se recomendó realizar una exploración adicional. El 0,67 por ciento de las mujeres han sido enviadas a unidades hospitalarias para valoración diagnóstica. Se ha confirmado un tumor maligno en el 0,34 por ciento de las mujeres exploradas. A 8,37 por ciento de las mujeres se les ha recomendado realizar una exploración intermedia antes de la nueva de cribado. Indicadores predictores de impacto: la captación global es de 88,68 por ciento, la participación global de 87,91 por ciento y la adherencia al programa de 96,32 por ciento. La tasa de detección alcanza la cifra de 3,95 por 1.000 mujeres exploradas. De los tumores detectados, 19,17 por ciento son intraductales, y 37,23 por ciento de los invasivos tienen un tamaño igual o inferior a 10 mm. El 74,89 por ciento del total de tumores no presenta invasión ganglionar. Conclusiones. Considerando las referencias que para programas de cribado establece la Unión Europea, todos los indicadores predictores calculados superan los estándares exigidos (AU)
Subject(s)
Aged , Female , Middle Aged , Humans , Mass Screening , Breast Neoplasms/diagnosis , Health Programs and Plans , Outcome and Process Assessment, Health CareABSTRACT
BACKGROUND: There is a general consensus on the recommendation of applying breast cancer screening programs to the population. In March 1990, the Health Department set in motion a Program for the Early Detection of Breast Cancer, with the aim of reducing mortality due to this tumour. At present, the program is reaching the end of its seventh round. The present study aims to analyze the results obtained, describing the principal indicators of the process and the impact predictions according to the most determinant factors. METHODS: Data was collected for the screening explorations carried out from the start of the program up until December 31st 2002; the data was classified according to age at the time of exploration, type of exploration and round. RESULTS: During the period, 354,575 explorations were carried out. Process indicators: an additional exploration was recommended for 11.22% of the women. Naught point sixty seven percent (0.67%) of the women were sent to hospital units for a diagnostic evaluation. A malignant tumour was confirmed in 0.34% of the women subjected to exploration. It was recommended that 8.37% of the women should carry out an intermediate exploration before the next call from the screening program. Predictive impact indicators: global recruitment was 88.68%; global participation 87.91%; and adherence to the program was 96.32%. The rate of detection reached the figure of 3.95 per 1,000 women explored. Of the tumours detected: 19.17% were intraductal and 37.23% of the invasive tumours had a size equal to or below 10mm. Seventy-four point eighty nine percent (74.89%) of total tumours did not show ganglionary invasion. CONCLUSIONS: Considering the references established by the European Union for screening programs, all of the calculated predictive indicators exceed the required standards.
