Helping women make choices about mammography screening: An online randomized trial of a decision aid for 40-year-old women

Objective

To evaluate the effect of a decision aid (DA) on women's knowledge of the benefits and harms of screening and on their ability to make an informed decision.

Methods

An online randomized controlled trial among 321 women aged 38-45 years was conducted. Participants were randomized to either immediate or delayed access to the online DA which (i) explained the benefits and harms, (ii) included a values clarification exercise and a worksheet to support decision making. The primary outcome, knowledge of benefits and harms of screening, and secondary outcomes, informed choice (composite of knowledge, values and intention), anxiety and acceptability of the DA were measured using online questionnaires.

Results

Women in the intervention group were more knowledgeable (mean score out of 10, 7.35 vs 6.27, p < 0.001) and were more likely to have made a decision (82% vs 61% p < 0.001). Of those who made a decision, women in the intervention group were less likely to start screening now (52% vs 65% p = 0.05). There was no significant difference in the proportion of women who made an informed choice (71% intervention group vs 64% control group, p = 0.24). The DA was helpful, balanced and clear, and did not make women anxious.

Conclusions

The DA increased knowledge and reduced indecision, without increasing feelings of anxiety.

Practice Implications

This decision aid is easy to access online and could be an inexpensive way of supporting women aged 40 who are considering whether to start screening now, or wait until they are 50. The results of this study demonstrate the potential of DAs to help inform women about both the benefits and risks of screening at this age and to support women and clinicians in this decision making process.     

Preoperative diagnostic accuracy of fine-needle aspiration in the management of breast lesions: Comparison of specificity and sensitivity with clinical examination,mammography, echography,and thermography in 249 patients

Two hundred and forty-nine women suffering from breast problems underwent a complete series of tests including clinical examination, mammography, echography, thermography, and fine-needle aspiration (FNA). Ninety-four of these patients were shown to be positive or to have suspected malignancy. Accordingly, they underwent surgical excision followed by histologic examination, while the remaining patients were re-examined after 12 to 18 mo in order to exclude false negatives. The analysis of specificity and sensitivity of every single procedure showed that FNA describes the best degree of sensitivity and specificity but no procedure allows, by itself, the detection of all carcinomas. When considered in combination, clinical examination, mammography, and fine-needle aspiration have a sensitivity of 100% and a specificity of 49%, and are the best diagnostic tests for a correct assessment of mammary lesions. Thermography and echography showed a low degree of sensitivity and should not be included in the routine diagnostic procedure of breast lesions. Diagn Cytopathol 1994; 11:4–8. © 1994 Wiley-Liss, Inc.     

Gabor filters and phase portraits for the detection of architectural distortion in mammograms

Architectural distortion is a subtle abnormality in mammograms, and a source of overlooking errors by radiologists. Computer-aided diagnosis (CAD) techniques can improve the performance of radiologists in detecting masses and calcifications; however, most CAD systems have not been designed to detect architectural distortion. We present a new method to detect and localise architectural distortion by analysing the oriented texture in mammograms. A bank of Gabor filters is used to obtain the orientation field of the given mammogram. The curvilinear structures (CLS) of interest (spicules and fibrous tissue) are separated from confounding structures (pectoral muscle edge, parenchymal tissue edges, breast boundary, and noise). The selected core CLS pixels and the orientation field are filtered and downsampled, to reduce noise and also to reduce the computational effort required by the subsequent methods. The downsampled orientation field is analysed to produce three phase portrait maps: node, saddle, and spiral. The node map is further analysed in order to detect the sites of architectural distortion. The method was tested with 19 mammograms containing architectural distortion. In a preliminary experiment, a sensitivity of 84% was obtained at 7.8 false positives per image.An erratum to this article can be found at     

Malacoplakia and rosai-dorfman disease: Two entities of histiocytic origin infrequently localized in the female breast—the cytologic aspect in aspirates obtained via fine-needle aspiration cytology

We describe one case of Rosai-Dorfman disease (RDD) localized in the breast and one case of breast malacoplakia (MPK) both diagnosed by fine-needle aspiration cytology (FNAC). In RDD the cytologic features were lymphocytophagocytosis, large histiocytes with slight nuclear atypia, and lymphohistiocytic aggregates in a polymorphous background which included frequent plasma cells. In MPK the key diagnostic feature was the presence of Michaelis-Gutmann bodies (M-G bodies), in various stages of evolution, intermingled with vacuolized medium-sized histiocytes, other inflammatory cells, and debris. Pap staining is the technique of choice to show lymphocytophagocytosis and M-G bodies and there is no need to resort to special staining methods. RDD and MPK share a common cytologic background: the presence of numerous benign reactive histiocytes, either engulfing apparently intact lymphocytes, or phagocytizing M-G bodies. The cytologic findings seen in both cases suggest that the presence of histiocytes in a breast aspirate is far from being nonspecific and can represent an important lead to disparate diseases such as RDD and MPK.     

钼靶X线摄影对乳腺积乳囊肿的诊断价值

目的：分析乳腺积乳囊肿的影像学特点,探讨钼靶X线摄影对其诊断与鉴别诊断的价值。材料与方法：结合临床对30例病理证实的乳腺积乳囊肿的X线平片进行回顾性分析。结果：哺乳期乳腺23例,致密型乳腺3例,分叶型乳腺2例,团块型乳腺1例,斑点型乳腺1例。X线均显示为类圆形块影。其中高密度型6例,低密度型11例,混杂密度型13例。边界清晰21例,边界部分清晰6例,边界模糊不清3例。结论：乳腺X线摄影结合穿刺抽液对乳腺积乳囊肿的诊断与鉴别诊断颇有价值。     

乳腺实性乳头状癌全数字化乳腺摄影表现与病理对照

目的:探讨乳腺实性乳头状癌(solid papillary carcinoma,SPC)的全数字化乳腺摄影(full-field digital mammography,FFDM)表现及临床病理特征,提高对该病的诊治水平。方法:回顾性分析经手术病理证实的15例乳腺SPC患者的资料,分析其临床病史、FFDM表现及病理特征,并对SPC的FFDM征象进行二项式检验。结果:15例SPC患者中,1例合并高级别导管内癌,1例合并黏液腺癌。13例患者FFDM图像上发现肿块,其中12例表现为高密度影;9例病灶边缘清晰,4例边缘模糊;13例均表现为边缘浅小分叶;5例病灶内见钙化。1例表现为不对称性致密影,1例未见明显肿块。二项式检验结果显示,边缘浅小分叶、高密度差异有统计学意义(P0.05),其他征象差异无统计学意义。结论:乳腺SPC的FFDM表现为边缘浅小分叶、高密度等,大多数病灶边缘清晰,且与病理特征相关。     

超声与钼靶摄影诊断乳腺导管内癌的对照研究

目的评价超声、钼靶摄影以及二者综合对乳腺导管内癌的诊断准确性。 方法分析经病理证实的83例乳腺导管内癌的钼靶摄影和超声表现，并比较其诊断准确性。 结果（1）超声表现腺体内低回声实性病变52例（62．7％），导管内实性结节16例（19．3％），囊性病变或乳腺导管扩张7例（8．4％），阴性8例（9．6％）；（2）钼靶摄影表现簇状微小钙化53例（63．9％），软组织结节或局部密度增高50例（60．2％），未发现明确病变者9例（10．8％）；（3）分类比较超声、钼靶摄影和二者综合分类为可能恶性者分别为47例、53例、67例，2种方法准确率差异无统计学意义（56．6％和63．9％，P=0．169）；综合2种方法后诊断准确率高于钼靶摄影（80．7％和63．9％，P〈0．001）。 结论超声和钼靶摄影诊断导管内癌的准确率较低。综合应用2种检查方法可提高诊断准确率。     

乳腺叶状囊肉瘤的临床X线分析

目的:认识乳腺叶状囊肉瘤的特异性与非特异性表现,提高其正确诊断率。材料与方法:回顾与分析经手术病理证实的20例乳腺叶状囊肉瘤的病理类型、临床X线表现及治疗情况。结果:该瘤病史较长,为单侧发。其中左侧11例,右侧9例,最小直径2cm,最大直径17cm。20例中无痛性肿块17例,肿块伴疼痛2例,伴胀坠感1例,乳头凹陷1例,乳头黄色溢液1例,皮肤破溃1例,腋下触及质软淋巴结2例。典型X线表现:边缘清晰的圆形或类圆形致密阴影,密度均匀,周围血管影增粗,瘤体较大时外形呈波浪形或多囊状,皮下脂肪层清晰。6例误诊为纤维腺瘤,2例误诊为乳腺癌,1例误诊为乳腺囊肿。20例均经手术切除治疗,病理证实为叶状囊肉瘤。结论:认识和掌握乳腺叶状囊肉瘤的病理类型、临床表现,结合X线所见综合分析是其术前诊断的关键。     

成簇样钙化对乳腺癌的诊断价值

目的：探讨乳腺癌成簇样钙化在乳腺X线片中的特征性表现，提高诊断和鉴别诊断的水平。方法：经手术病理证实并在乳腺X线片中成簇样钙化的病例54例，分析成簇样钙化的形态、大小、密度等特征及其在诊断乳腺癌中的价值。结果：乳腺癌常见的钙化形态为细沙型和混合型；良性病变的成簇样钙化的整体形状多呈类圆形或椭圆形，而且钙化颗粒较大、密度较高、大小较均匀，而乳腺癌的钙化簇的整体形状多呈不规则形；87．5％乳腺癌的钙化点密度不均、大小不一；81．3％乳腺癌的每平方厘米钙化数目（N／S）〉15个。结论：乳腺X线片中成簇样钙化形态学表现和数目、密度、大小对乳腺癌的诊断具有重要价值。