The use of additional imaging increased specificity and decreased sensitivity in screening mammography.
OBJECTIVE
To examine the use of additional imaging after standard mammographic screening views to better understand the value of these additional testing in improving accuracy.


METHODS
Statewide population data on screening mammography were used to report accuracy measures at screening and after additional imaging tests. Pathology data from biopsies performed within 1 year following the screening mammogram were used to determine cancer outcome (489 in situ and invasive cancers). Pathologic and population characteristics of women receiving different types of imaging were assessed by chi-square or t-tests. Similar tests compared women with the same imaging and differing outcomes.


RESULTS
Of 77,799 women with screening mammograms 9.9% had additional imaging. Additional imaging reduced false positives from 7,765 (100/1,000 mammograms) to 1,112 (14/1,000 mammograms). The majority of false negatives (82%) occurred in women receiving only screening views, and additional imaging increased the number of false negatives from 82 (1/1,000 mammograms) to 115 (1.5/1,000 mammograms).


CONCLUSIONS
Additional imaging can reduce unnecessary biopsy but at the cost of some additional false negatives. Additional imaging's potential for improving the sensitivity of screening is limited because most missed cancers occur in women who do not have additional imaging.
Geller
Berta M
BM
University of Vermont, Office of Health Promotion Research, Departments of Family Practice and Radiology, Vermont Cancer Center, 1 South Prospect Street, Burlington, VT 05401-3444, USA. berta.geller@uvm.edu
Vacek
Pamela M
PM
Skelly
Joan
J
Harvey
Susan C
SC
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D002278:Carcinoma in Situ / Q000000981:diagnostic imaging / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology; D003951:Diagnostic Errors; D005192:Family Health; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014463:Ultrasonography