title: Avoidable surgical consultations in women with a positive screening mammogram: experience from a southern region of the Dutch breast screening programme.
abstract: BACKGROUND
  According to current Dutch guidelines, all women with a positive screening mammogram are referred for a full hospital assessment, which includes surgical consultation and radiological assessment. Surgical consultation may be unnecessary for many patients. Our objective was to determine how often surgical consultations can be avoided by radiological pre-assessment.
  
  
  METHODS
  All women with a positive screening mammogram, referred to our radiology department between 2002 and 2007, were included (n=1014). Percentage of women that was downstaged to BI-RADS category 1 or 2 by radiological pre-assessment was calculated. Negative predictive value (NPV) for malignancy was estimated from the in-hospital follow-up, which was available up to September 2012.
  
  
  RESULTS
  423 of 1014 women (42%) were downstaged to BI-RADS category 1 or 2 by radiological pre-assessment. During follow-up, 8 of these 423 women (2%) developed a malignancy in the same breast. At least 6 of these malignancies were located at a different location as the original screening findings which led to the initial referral. The estimated NPV for malignancy was 99.5% (95%CI, 98.3-99.9).
  
  
  CONCLUSIONS
  By referring women with a positive screening mammogram to the radiology department for pre-assessment, a surgical consultation was avoided in 42%, with an estimated NPV of 99.5% for malignancy.
authors.affiliation: Department of Radiology, Atrium Medical Center Parkstad, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands. Electronic address: schreutelkamp@home.nl.
authors.forename: J L
authors.initials: JL
authors.lastname: Schreutelkamp
authors.affiliation: Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands. Electronic address: rmkwee@gmail.com.
authors.forename: R M
authors.initials: RM
authors.lastname: Kwee
authors.affiliation: Department of Radiology, Atrium Medical Center Parkstad, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands. Electronic address: machiel_de_booij@hotmail.com.
authors.forename: M
authors.initials: M
authors.lastname: de Booij
authors.affiliation: Department of Radiology, Atrium Medical Center Parkstad, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands. Electronic address: miraude@gmail.com.
authors.forename: M E A P M
authors.initials: ME
authors.lastname: Adriaensen
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008408:Mastectomy / Q000706:statistics & numerical data*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012307:Risk Factors; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*
keywords: Breast cancer; Full hospital assessment; Radiological assessment; Screening; Surgical consultation