In-depth Retrospective Review of Originally Negative Screening Mammograms from Women with Confirmed Breast Cancer

Lieve Vandendaele; Svetlana Jidkova; Koen Van Herck; Tom Kimpe; Veerle Verschuere

doi:10.5334/jbsr.2796

Figures & Tables

Table 1

Descriptive analyses of sMx and tumour characteristics.

DESCRIPTIVE DATA	N	%
Total	210	100
Age at prior sMx¹
50–54 years	55	26.2
55–59 years	56	26.7
60–64 years	74	35.2
65–69 years	25	11.9
Date of prior sMx
2009	29	13.8
2010	99	47.1
2011	82	39
Interval between prior and index sMx
17–20 months	19	9
21–24 months	169	80.5
25–28 months	22	10.5
Arbitration needed for prior sMx
No arbitration	189	90
Arbitration	21	10
Digital technique of prior sMx
Computed Radiography (CR)	71	33.8
Direct readout digital Radiography (DR)	139	66.2
Tumour size
<T2²	169	80.5
≥T2	37	17.6
Missing	4	1.9
Type of tumour
In situ	29	13.8
Invasive	181	86.2
Staging
Stage 0 (in situ)	26	12.4
Stage IA	95	45.2
Stage IB	13	6.2
Stage IIA	40	19
Stage IIB	12	5.7
Stage IIIA	7	3.3
Stage IIIC	5	2.4
Stage IV	8	3.8
Missing	4	1.9

[i] ¹ sMx: screening mammogram. ² T2: Tumour more than 2 cm but not more than 5 cm in greatest dimension.

Table 2

The results of the expert review of the prior sMx.

STEP 1 REVIEW OF PRIORS ONLY	N	%
Total	210	100
Image quality of prior sMx¹
Good	148	70
Not good technical physical	20	10
Not good positioning	28	13
Not good technical physical nor positioning	14	7
Breast Density on prior sMx
0–25%	80	38.1
26–50%	62	29.5
51–75%	64	30.5
76–100%	4	1.9
Step 1 Bi-RADS categories: Review of prior sMx
No lesion	98	46.7
Benign lesion(s)	41	19.5
Probably benign	47	22.4
Probably malignant	24	11.4
Malignant	0	0
Total	210	100
Step 2 interim classification: Reviewing priors with index sMx available
Without suspicious lesions	97	46.2
Minimal signs	88	41.9
Clearly visible tumour	25	11.9
Total	210	100
Step 3 final classification: Reviewing priors with index sMx and clinical information available
Without suspicious lesions	94	44.8
Minimal signs	77	36.7
Clearly visible tumour	39	18.6
Total	210	100

[i] ¹ sMx: screening mammogram.

Table 3

Univariate analyses: Variables significantly associated with the interim or final classification after reviewing prior mammograms.

A. UNIVARIATE ANALYSES: VARIABLES SIGNIFICANTLY ASSOCIATED WITH THE INTERIM CLASSIFICATION (STEP 2) AFTER REVIEWING PRIORS WITH INDEX IMAGES PRESENT.
VARIABLE & CLASSES	WITHOUT SUSPICIOUS LESIONS	MINIMAL SIGNS	CLEARLY VISIBLE TUMOURS	TOTAL	PEARSON CHI-SQUARE
	97	88	25	210
Need of arbitration on prior imaging					0.002
No arbitration	93 (49%)	78 (41%)	18 (10%)	189
Arbitration	4 (19%)	10 (48%)	7 (33%)	21
Date of prior imaging					<0.001
Earliest tertile	32 (67%)	15 (31%)	1 (2%)	48
Intermediate tertile	40 (51%)	31 (39%)	8 (10%)	79
Latest tertile	25 (30%)	42 (51%)	16 (19%)	83
B. UNIVARIATE ANALYSES: VARIABLES SIGNIFICANTLY ASSOCIATED WITH THE FINAL CLASSIFICATION (STEP 3) AFTER REVIEWING PRIORS WITH INDEX IMAGES AND CLINICAL INFORMATION PRESENT.
VARIABLE & CLASSES	WITHOUT SUSPICIOUS LESIONS	MINIMAL SIGNS	CLEARLY VISIBLE TUMOURS	TOTAL	PEARSON CHI-SQUARE
	94	77	39	210
Need of arbitration on prior imaging					0.004
No arbitration	90 (48%)	69 (37%)	30 (16%)	189
Arbitration	4 (19%)	8 (38%)	9 (43%)	21
Date of prior imaging					<0.001
Earliest tertile	31 (65%)	15 (31%)	2 (4%)	48
Intermediate tertile	39 (49%)	27 (34%)	13 (17%)	79
Latest tertile	24 (29%)	35 (42%)	24 (29%)	83
Image quality at the tumour side					0.004
Good	76 (43%)	59 (38%)	21 (14%)	156
Not good	18 (33%)	18 (33%)	18 (33%)	54
Detector system used					0.036
Computed Radiography CR	29 (41%)	22 (31%)	20 (28%)	71
Direct Readout Digital Radiography DR	65 (47%)	55 (40%)	19 (14%)	139

Table 4

Multivariate analyses: Variables associated with the interim or final classification after reviewing prior mammograms.

A. MULTIVARIATE ANALYSES: VARIABLES ASSOCIATED WITH THE INTERIM CLASSIFICATION (STEP 2) AFTER REVIEWING PRIORS WITH INDEX IMAGES PRESENT.
VARIABLES & CLASSES	CLEARLY VISIBLE TUMOURS COMPARED TO NO OR MINIMAL SIGNS			CLEARLY VISIBLE TUMOURS COMPARED TO NO SIGNS
VARIABLES & CLASSES	ODDS RATIO	95% CONFIDENCE INTERVAL	p-VALUE	ODDS RATIO	95% CONFIDENCE INTERVAL	p-VALUE
Need of arbitration on prior images			0.005			0.001
No arbitration	1			1
Arbitration	4.85	(1.61–14.61)	0.005	16.65	(2.98–93.00)	0.001
Date of prior imaging			0.044			0.004
Earliest tertile	11.13	(1.39–88.93)	0.024	39.71	(3.43–459.09)	0.003
Intermediate tertile	5.75	(0.68–48.72)	0.109	12.30	(1.06–142.17)	0.045
Latest tertile	1			1
Image quality at the tumour side			0.510			0.220
Good	1			1
Not good	1.40	(0.52–3.78)	0.510	2.02	(0.66–6.20)	0.220
B. MULTIVARIATE ANALYSES: VARIABLES ASSOCIATED WITH THE FINAL CLASSIFICATION (STEP 3) AFTER REVIEWING PRIORS WITH INDEX IMAGES AND CLINICAL INFORMATION PRESENT.
VARIABLE & CLASSES	CLEARLY VISIBLE TUMOURS COMPARED TO NO OR MINIMAL SIGNS			CLEARLY VISIBLE TUMOURS COMPARED TO NO SIGNS
VARIABLE & CLASSES	ODDS RATIO	95% CONFIDENCE INTERVAL	p-VALUE	ODDS RATIO	95% CONFIDENCE INTERVAL	p-VALUE
Need of arbitration on prior images			0.001			0.001
No arbitration	1			1
Arbitration	5.72	(1.99–16.43)	0.001	12.24	(2.80–53.52)	0.001
Date of prior imaging			0.006			0.001
Earliest tertile	11.30	(2.30–55.46)	0.003	29.13	(4.40–193.06)	<0.001
Intermediate tertile	5.66	(1.11–28.81)	0.037	10.13	(1.53–67.12)	0.016
Latest tertile	1			1
Image quality at the tumour side			<0.001			<0.001
Good	1
Not good	4.41	(1.96–9.34)				<0.001