Breast cancer mammographic diagnosis performance in a public health institution: a retrospective cohort study

Insights into Imaging, Oct 2017

Objectives To evaluate the quality assurance of mammography results at a reference institution for the diagnosis and treatment of breast cancer in southern Brazil, based on the BIRADS (Breast Imaging Reporting and Data System) 5th edition recommendations for auditing purposes. Materials and methods Retrospective cohort and cross-sectional study with 4502 patients (9668 mammographies)) who underwent at least one or both breast mammographies throughout 2013 at a regional public hospital, linked to a federal public university. The results were followed until 31 December 2014, including true positives (TPs), true negatives (TNs), false positives (FPs), false negatives (FNs), positive predictive values (PPVs), negative predictive value (NPV), sensitivity and specificity, with a confidence interval of 95%. Results The study showed high quality assurance, particularly regarding sensitivity (90.22%) and specificity (92.31%). The overall positive predictive value (PPV) was 65.35%, and the negative predictive value (NPV) was 98.32%. The abnormal interpretation rate (recall rate) was 12.26%. Conclusions The results are appropriate when compared to the values proposed by the BIRADS 5th edition. Additionally, the study provided self-reflection considering our radiological practice, which is essential for improvements and collaboration regarding breast cancer detection. It may stimulate better radiological practice performance and continuing education, despite possible infrastructure and facility limitations. Main Messages • Accurate quality performance rates are possible despite financial and governmental limitations. • Low-income institutions should develop standardised teamwork to improve radiological practice. • Regular mammography audits may help to increase the quality of public health systems.

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Breast cancer mammographic diagnosis performance in a public health institution: a retrospective cohort study

Insights Imaging Breast cancer mammographic diagnosis performance in a public health institution: a retrospective cohort study Juliana M.R.B. Mello 0 1 2 4 Fernando P. Bittelbrunn 0 1 2 4 Marcio A. B. C. Rockenbach 0 1 2 4 Guilherme G. May 0 1 2 4 Leonardo M. Vedolin 0 1 2 4 Marilia S. Kruger 0 1 2 4 Matheus D. Soldatelli 0 1 2 4 Guilherme Zwetsch 0 1 2 4 Gabriel T. F. de Miranda 0 1 2 4 Saone I. P. Teixeira 0 1 2 4 Bruna S. Arruda 0 1 2 4 Abbreviations ACR BIRADS BCSC CI FN FP HCPA 0 1 2 4 0 Neuroradiology Department, Hospital Moinhos de Vento , Porto Alegre , Brazil 1 Radiological Department, Hospital de Clínicas de Porto Alegre (HCPA) , 2350, Ramiro Barcelos St. Second floor, Porto Alegre 90035-903 , Brazil 2 Fernando P. Bittelbrunn 3 Juliana M.R.B. Mello 4 American College of Radiology Breast Imaging Reporting and Data System Breast Cancer Surveillance Consortium Confidence interval False negative False positive Hospital de Clínicas de Porto Alegre (Porto Alegre's Clinical Hospital) Instituto Nacional do Câncer (Cancer National Institute) Positive predictive value Negative predictive value Objectives To evaluate the quality assurance of mammography results at a reference institution for the diagnosis and treatment of breast cancer in southern Brazil, based on the BIRADS (Breast Imaging Reporting and Data System) 5th edition recommendations for auditing purposes. Materials and methods Retrospective cohort and crosssectional study with 4502 patients (9668 mammographies)) who underwent at least one or both breast mammographies throughout 2013 at a regional public hospital, linked to a federal public university. The results were followed until 31 December 2014, including true positives (TPs), true negatives (TNs), false positives (FPs), false negatives (FNs), positive predictive values (PPVs), negative predictive value (NPV), sensitivity and specificity, with a confidence interval of 95%. Results The study showed high quality assurance, particularly regarding sensitivity (90.22%) and specificity (92.31%). The overall positive predictive value (PPV) was 65.35%, and the negative predictive value (NPV) was 98.32%. The abnormal interpretation rate (recall rate) was 12.26%. Conclusions The results are appropriate when compared to th e v alu es pro po se d b y t he BI RADS 5 th edi tion . Additionally, the study provided self-reflection considering our radiological practice, which is essential for improvements and collaboration regarding breast cancer detection. It may stimulate better radiological practice performance and continuing education, despite possible infrastructure and facility limitations. Main Messages Accurate quality performance rates are possible despite financial and governmental limitations. Low-income institutions should develop standardised teamwork to improve radiological practice. Regular mammography audits may help to increase the quality of public health systems. Mammography auditing; Breast cancer; Quality assurance; SISMAMA; Public health INCA SISMAMA TN TP Introduction Sistema de Informação do Câncer de Mama (Breast Cancer Information System) True negative True positive The main goal of breast cancer screening is to reduce mortality rates through early detection and proper treatment [ 1–6 ]. Great effort has been made in the last years by the international scientific community, particularly in the radiology field, to achieve this goal [ 7–9 ]. Recently, a systematic review showed a decrease of at least 20% for the mortality rate due to the use of mammography for breast cancer screening [10]. Another study attributes most of the decrease in the breast cancer mortality rate of at least 38% since 1990 to early mammography detection [ 11 ]. Nevertheless, uncertainties remain about the magnitude of overdiagnosis associated with different possible screening strategies [ 10 ]. Meanwhile, the main imaging modality for breast cancer screening is still mammography [ 12, 13 ]. As a method of standardising the process of reporting mammograms and also with the objective of facilitating data collection, the American College of Radiology (ACR) created the lexicon published in the atlas BBreast Imaging Reporting and Data System (BIRADS)^, which is used worldwide as a single and united system for the breast imaging radiology subspecialty [ 13 ]. It provides a guide to mammography audits and performance measures [ 14 ]. Mammography auditing assumes a relevant role when discussing the quality of breast imaging, whether regarding the radiologist’s interpretation or the quality of the images taken [ 1, 15, 6 ]. The majority of developed countries, such as the USA, have a federal standardisation for evaluating the personal performance of a radiologist as well as the imaging centres [ 9, 16, 17 ]. In Europe, for example, there is the Dutch Reference Centre of Screening, which conducts triennial audits of 17 mammography performing centres [ 18 ]. In this European programme, th (...truncated)


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Juliana M.R.B. Mello, Fernando P. Bittelbrunn, Marcio A. B. C. Rockenbach, Guilherme G. May, Leonardo M. Vedolin, Marilia S. Kruger, Matheus D. Soldatelli, Guilherme Zwetsch, Gabriel T. F. de Miranda, Saone I. P. Teixeira, Bruna S. Arruda. Breast cancer mammographic diagnosis performance in a public health institution: a retrospective cohort study, Insights into Imaging, 2017, pp. 581-588, Volume 8, Issue 6, DOI: 10.1007/s13244-017-0573-2