Impact of a CAD system in a screen-film mammography screening program: a prospective study.

OBJECTIVE: The purpose of our study was to perform a prospective assessment of the impact of a CAD system in a screen-film mammography screening program during a period of 3 years. MATERIALS AND METHODS: Our study was carried out on a population of 21,855 asymptomatic women (45-65 years). Mammograms were processed in a CAD system and independently interpreted by one of six radiologists. We analyzed the following parameters: sensitivity of radiologist's interpretation (without and with CAD), detection increase, recall rate and positive predictive value of biopsy, CAD's marks, radiologist's false negatives and comparative analysis of carcinomas detected and non-detected by CAD. RESULTS: Detection rate was 4.3‰. CAD supposed an increase of 0.1‰ in detection rate and 1% in the total number of cases (p<0.005). The impact on recall rate was not significant (0.4%) and PPV of percutaneous biopsy was unchanged by CAD (20.23%). CAD's marks were 2.7 per case and 0.7 per view. Radiologist's false negatives were 13 lesions which were initially considered as CAD's false positives. CONCLUSIONS: CAD supposed a significant increase in detection, without modifications in recall rates and PPV of biopsy. However, better results could have been achieved if radiologists had considered actionable those cases marked by CAD but initially misinterpreted.

Percutaneous microductectomy with a directional vacuum-assisted system guided by ultrasonography for the treatment of breast discharge: experience in 63 cases.

BACKGROUND: Vacuum-assisted devices are becoming a useful tool in the diagnosis and treatment of breast pathology. Recent publications show good results in percutaneous removal of benign lesions. PURPOSE: To discuss our experience in percutaneous excision of ductal lesions with a vacuum-assisted, ultrasound-guided directional system. MATERIAL AND METHODS: From January 2003 to July 2006, 63 patients with pathological nipple discharge and intraductal lesion identifiable on imaging were studied at two reference centers. Percutaneous excision with a vacuum-assisted device was offered as an alternative to surgery. RESULTS: A total of 71 lesions were diagnosed in 63 patients with a mean age of 52 years. All the patients presented nipple discharge. Mammography was normal in 65 cases (92%). Galactography showed an intraductal lesion in 67 cases (94%). Mean lesion size on ultrasonography was 7.4 mm (2-26 mm). Percutaneous excision was performed in 45 lesions (63%), while surgical excision was indicated in 26 lesions. The histopathological results in the 45 lesions biopsied demonstrated intraductal papilloma in 30 cases, dilated duct with papillomatous projections in 11, ductal ectasia with no papillary lesion in three, and a nonspecific benign result in one. Excision was considered complete in 41 lesions (91%). Clinical signs of discharge were resolved in 39 patients (95% of cases treated percutaneously). Mild complications occurred in four cases. CONCLUSION: Percutaneous excision of ductal lesions with an ultrasound-guided, vacuum-assisted device is a safe procedure with high diagnostic and therapeutic value for the management of breast discharge.

Análisis de los resultados clínicos y la carga asistencial del screening oportunista en una Unidad de Diagnóstico por la Imagen de la Mama / Analysis of the clinical results and the nursing workloads and costs of opportunist screening in a Breast Diagnostic Imaging Unit

El objetivo de este trabajo es analizar el impacto diagnóstico y la carga asistencial del screening oportunista (SO). Se analizó la actividad desarrollada entre 2003 y 2006. Se estudiaron 24.317 pacientes (9.487 remitidas como SO) y se realizaron44.269 mamografías en el Programa Poblacional. El SO supuso el 42% de la demanda, 39% de pacientes, 33,69% de estudios y 22,32% de costes. El coste/carcinoma fue 964 URVs, frente a 461,16 URVs en Programa y 195,64 URVs en sintomáticas. El SO supone un alto volumen de actividad y consumo de recursos. Es necesario reducir la carga asistencial promoviendo la participación en Programas e introduciendo estrategias de gestión para reducir costes (AU)

The objective of this work is to analyse the diagnostic impact and nursing workloads and costs of opportunist screening (OS). After analyzing the diagnostic impact and nursing workloads and costs of opportunist screening (OS). After analyzing the activity carried out between 2003 and 2006, a high volume of activity and consumption of resources is observed. It thus concludes that it is necessary to reduce the nursing workloads and costs encouraging the participation in Programmes and introducing management strategies to reduce costs (AU)