Medical Audit of Screening Mammography at a Tertiary Referral Hospital Using the 5th Edition of Breast Imaging Reporting and Data System

Jung Hee Byon; Min Jung Kim; Vivian Youngjean Park; Jung Hyun Yoon; Hee Jung Moon; Eun-Kyung Kim

doi:10.3348/jksr.2019.80.3.513

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Byon, Kim, Park, Yoon, Moon, and Kim: Medical Audit of Screening Mammography at a Tertiary Referral Hospital Using the 5th Edition of Breast Imaging Reporting and Data System

Breast Imaging

Original Article

Journal of the Korean Society of Radiology 2019; 80(3): 513-523.

Published online: 31 May 2019

DOI: https://doi.org/10.3348/jksr.2019.80.3.513

Medical Audit of Screening Mammography at a Tertiary Referral Hospital Using the 5th Edition of Breast Imaging Reporting and Data System

Jung Hee Byon, MD^†

, Min Jung Kim, MD

, Vivian Youngjean Park, MD, Jung Hyun Yoon, MD, Hee Jung Moon, MD, Eun-Kyung Kim, MD

Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author: Min Jung Kim, MD. Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel 82-2-2228-7400, Fax 82-2-2227-8337, mines@yuhs.ac

Current affiliation:

†Current address Department of Radiology, Chonbuk National University Hospital and Medical School, Jeonju, Korea

Received 25 April 2018 Revised 9 July 2018 Accepted 24 August 2018

The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to analyze medical audit of screening digital mammography at a tertiary hospital and to review changes of medical audit according to newly revised standard.

Materials and Methods

We analyzed 7764 asymptomatic women who underwent screening mammogram at our hospital from January, 2013 to December, 2014. The family or past history of breast, gynecologic and other cancers was reviewed retrospectively. Analysis 1 defined category 3 as positive result and analysis 2 defined category 3 as negative.

Results

The overall cancer detection rate was 4.6 per 1000 cases. The cancer detection rate in patients with non-gynecological and non-thyroid cancer (n = 391, 51.2) was the highest compared to patients with family history of breast cancer (n = 691, 1.4), or gynecological cancer (n = 311, 12.9). In analysis 1, positive predictive value 1 decreased 1.3% (6.0% vs. 7.3%) and recall rate increased 1.3% (7.3% vs. 6.0%) compared with analysis 2. The results were appropriate for newly revised target.

Conclusion

The results of screening digital mammography in the tertiary medical institution showed excellent results even if category 3 was regarded as positive. In addition, screening tests for secondary cancer are needed in the tertiary hospital.

Keywords: Breast Cancer, Medical Audit, Mammography, Screening, Tertiary Care Centers

Figures and Tables

Table 1

Age Distribution and Cancer Detection Rate of Women Screened in This Study

Table 2

Patients with Risk Factors Associated with Breast Cancer and Rate of Cancer Detection among These Patients

340 patients who have two or more risk factors were not shown on this table because it is difficult to compare the incidence of breast cancer by risk factors. 10 cancers were found among them resulting 29.4 cancers per 1000 cases.

^*Including over 1st degree relatives.

^†Including atypical ductal hyperplasia, intraductal papilloma, radial scar, mucocele like lesion, lobular carcinoma in situ, atypical lobular hyperplasia, and atypical papilloma.

^‡Involving uterus, ovary, cervix, or endometrium.

^§Including gastrointestinal tract cancer (esophagus, stomach, colon, and rectum), lung cancer, renal cell carcinoma, bladder cancer, lymphoma, leukemia, nasopharyngeal cancer, multiple myeloma, leiomyosarcoma, and basal cell carcinoma.

Table 3

Biopsy Recommendation and Performed Biopsy According to BI-RADS 4th Edition

Medical audit according BI-RADS 4th edition.

BI-RADS = Breast Imaging Reporting and Data System

Table 4

Analysis of Medical Audit Data: According to Analysis 1 and Analysis 2

^*Medical audit according BI-RADS 5th edition.

^†Medical audit according BI-RADS 4th edition.

BI-RADS = Breast Imaging Reporting and Data System

Table 5

False-Negative Cases

^*All false-negative cases were diagnosed as interval cancer, with symptoms or cancer diagnosed by ultrasound.

^†Duration between screening examination and cancer diagnosis.

Table 6

Mammographic Findings of Breast Cancer Detected on Screening Mammography

Table 7

Comparison of Medical Audit Data of Our Institute with BCSC Benchmarks

_*Medical audit according BI-RADS 5th edition.

^†Medical audit according BI-RADS 4th edition.

BCSC = Breast Cancer Surveillance Consortium , BI-RADS = Breast Imaging Reporting and Data System

Table 8

Comparison of Medical Audit Data of Our Institute with Those of Other Domestic Health Centers

Notes

^{Conflicts of Interest} The authors have no potential conflicts of interest to disclose.

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ORCID iDs

Jung Hee Byon
https://orcid.org/0000-0002-5139-552X

Min Jung Kim
https://orcid.org/0000-0003-4949-1237

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