Real-time reading in mammography breast screening.
OBJECTIVE
This study was undertaken to assess the role of real-time reading in the mammography screening programme carried out at the Hospital of Marzana, Verona, Italy.


METHODS
During the 5-year period 1999-2004, 54,472 women attended the screening programme (32,291 first calls: unadjusted uptake 41.4%, adjusted uptake 50.3%; 21,551 2- year routine recalls: unadjusted uptake 86.4%, adjusted uptake 89.9%). Further diagnostic investigations [(FDI), imaging and cytohistological] were performed immediately after real-time reading of the screening mammograms (FDI rate among first calls 10.9%; FDI rate among 2-year recalls 5.4%). Overall, cytohistological FDI were requested in 27% of imaging FDI, with a clear prevalence of cytological [fine-needle aspiration cytology (FNAC) 87%] over histological procedures [core needle biopsy (CNB) 11%; vacuum aspiration biopsy (VAB) 2%].


RESULTS
Imaging FDI proved to be conclusive in 73%. Cytohistological FDI led to the use of surgical biopsy (SB) in 39.5% (ratio between benign and malignant SB: 0.19/first calls, 0.14/2-year recalls). There were a total of 427 screen-detected breast cancers (BC), with a very good breast cancer detection rate (BCDR/first calls 9.7 per thousand; BCDR/2-year recalls 5.1 per thousand). In the 427 screen-detected BC, the incidence of pTis, pT1a,b cancers was 59.6% (diagnostic anticipation); the incidence of pN0 cancers was 61.2%; the incidence of conservative surgical procedures was 78.6%. In interval cancers, the false negative rate was 8.3% only, whereas the proportional incidence was very low indeed (14% first year; 38% second year).


CONCLUSIONS
The high sensitivity exhibited by the Marzana mammography screening programme suggests that the value of real-time reading should be validated by other programmes adopting a similar approach.
Mariotto
R
R
Centro di Prevenzione Senologica, Ospedale di Marzana, Piazza R. Lambranzi 1, I-37034, Verona, and Istituto di Anatomia Patologica, Università degli Studi di Verona, Italy. r.mariotto@tiscali.it
Brancato
B
B
Bonetti
F
F
Manfrin
E
E
Strabbioli
M
M
Mercanti
A
A
Falsirollo
F
F
Bricolo
P
P
Pistolesi
G F
GF
D001706:Biopsy; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006801:Humans; D007558:Italy; D008327:Mammography / Q000379:methods*; D008403:Mass Screening / Q000379:methods; D009367:Neoplasm Staging; D012680:Sensitivity and Specificity