Two-view versus single-view mammography at subsequent screening in a region of the Dutch breast screening programme

We retrospectively determined the effect of analogue two-view mammography versus single-view mammography at subsequent screens on breast cancer detection and determined financial consequences for a current digital mammography setting. Two screening radiologists reviewed the mammograms of 536 screen detected cancers (SDCs) and 171 interval cancers (ICs) with single-view mammography (medio-lateral-oblique view) at the last but one screen (SDCs) or latest screen (ICs). They determined whether two-view mammography at the last (but one) screen could have increased the cancer detection rate at that screening round. For subsequent screens, the radiologists also assessed the percentage of SDCs and ICs that had been missed at previous two-view screening mammography (SDC) or latest two-view screening (IC), respectively. Additional personnel and digital storage costs for standard two-view mammography at subsequent screening were calculated for digital screening. Two-view mammography could have facilitated earlier cancer detection in 40.9% (219/536) of SDCs and 39.8% (68/171) of ICs. For two-view screens, 24.4% of SDCs (213/871) were missed at previous two-view screening and 29.3% of ICs (110/375) were missed at the latest screen. Overall costs increase € 1.03/screen after implementation of digital two-view mammography. Standard two-view mammography at subsequent screening may modestly increase cancer detection at an earlier stage, whereas additional screening costs are limited.     

Baseline screening mammography: one vs two views per breast

To compare the advantages of one-view vs two-view mammography screening, films were reviewed for 2500 consecutive asymptomatic women undergoing baseline mammography. To provide screening at low cost, examinations were limited to two radiographs per breast, one each in the craniocaudal and mediolateral oblique projections, with the understanding that those few patients with detected abnormalities would require additional mammograms, taken with an individually directed, problem-solving approach, at considerably higher cost. Two separate interpretations were made of each case, one using only the oblique projection images, the other using both oblique and craniocaudal views. Two-view interpretations not only identified more cancers than one-view readings (27 vs 25), they also required fewer additional mammograms to evaluate potential abnormalities (179 vs 642, 7% vs 26%). These advantages outweigh the additional radiation risk and added cost. Baseline screening mammography should be done with two views per breast.     

Efficacy of the lateral view mammogram in the detection of breast malignancy.

Previous studies suggest that single-view lateral mammography alone results in a small decrease in detection of malignancies. Detection rates for lateral view only and two-view examinations in 200 cases (100 malignant, 100 nonmalignant) were compared. Four to six per cent of cases originally found positive were reinterpreted as negative in both situations. Preliminary findings suggest that the lateral view alone is sufficient, provided a second view is requested in suspicious cases.     

Two-view mammography at the incident round has improved the rate of screen-detected breast cancer in Wales

AIM: To investigate whether pre-invasive and invasive cancer detection rates were improved in Wales after the introduction of two views at incident screens. METHODS: The records of women attending follow-up screening for 2 years before and 2 years after the introduction of two-view incident screening were analysed. Cancer detection rates were compared before and after introduction of two view screening. RESULTS: At the incident round 98,752 women had one and 95,464 had two views. Five hundred and fifty-five cancers were detected with one view and 744 with two, an increased detection rate from 5.6 to 7.8 cancers per 1000 women screened (p=0.01). Two hundred and thirty-nine small cancers were detected with one view and 323 with two, increasing the detection rate from 2.4 to 3.4 per 1000 women screened (p=0.05). CONCLUSIONS: Two-view mammography at incident rounds detects more cancers and more favourable prognosis small cancers than single-view mammograms.     

Breast masses: computer-aided diagnosis with serial mammograms

PURPOSE: To retrospectively evaluate effects of computer-aided diagnosis (CAD) involving an interval change classifier (which uses interval change information extracted from prior and current mammograms and estimates a malignancy rating) on radiologists' accuracy in characterizing masses on two-view serial mammograms as malignant or benign. MATERIALS AND METHODS: The data collection protocol had institutional review board approval. Patient informed consent was waived for this HIPAA-compliant retrospective study. Ninety temporal pairs of two-view serial mammograms (depicting 47 malignant and 43 benign biopsy-proved masses) were obtained from 68 patient files and were digitized. Biopsy was the reference standard. Eight Mammography Quality Standards Act of 1992-accredited radiologists and two breast imaging fellows assessed digitized two-view temporal pairs (in preselected regions of interest only) by estimating likelihood of malignancy and Breast Imaging Reporting and Data System (BI-RADS) category without and with CAD. Observers' rating data were analyzed with Dorfman-Berbaum-Metz (DBM) multireader multicase method. Statistical significance of differences was estimated with the DBM method and Student two-tailed paired t test. RESULTS: Average area under the receiver operating characteristic curve for likelihood of malignancy across the 10 observers was 0.83 (range, 0.74-0.88) without CAD and improved to 0.87 (range, 0.80-0.92) with CAD (P < .05). The average partial area index above a sensitivity of 0.90 for likelihood of malignancy was 0.35 (range, 0.13-0.54) without CAD and 0.49 (range, 0.18-0.73) with CAD--a nonsignificant improvement (P = .11). For BI-RADS assessment, it was estimated that with CAD, six radiologists would correctly recommend additional biopsies for malignant masses (range, 4.3%-10.6%) and five would correctly recommend reduction of biopsy (ie, fewer biopsies) for benign masses (range, 2.3%-9.3%). However, five radiologists would incorrectly recommend additional biopsy for benign masses (range, 2.3%-14.0%), and one would incorrectly recommend reduction of biopsy (4.3%). CONCLUSION: CAD involving interval change analysis of preselected regions of interest can significantly improve radiologists' accuracy in classifying masses on digitized screen-film mammograms as malignant or benign.     

Performance benchmarks for diagnostic mammography

PURPOSE: To evaluate a range of performance parameters pertinent to the comprehensive auditing of diagnostic mammography examinations, and to derive performance benchmarks therefrom, by pooling data collected from large numbers of patients and radiologists that are likely to be representative of mammography practice in the United States. MATERIALS AND METHODS: Institutional review board approval was met, informed consent was not required, and this study was Health Insurance Portability and Accountability Act compliant. Six mammography registries contributed data to the Breast Cancer Surveillance Consortium (BCSC), providing patient demographic and clinical information, mammogram interpretation data, and biopsy results from defined population-based catchment areas. The study involved 151 mammography facilities and 646 interpreting radiologists. The study population included women 18 years of age or older who underwent at least one diagnostic mammography examination between 1996 and 2001. Collected data were used to derive mean performance parameter values, including abnormal interpretation rate, positive predictive value (for abnormal interpretation, biopsy recommended, and biopsy performed), cancer diagnosis rate, invasive cancer size, and the percentages of minimal cancers, axillary node-negative invasive cancers, and stage 0 and I cancers. Additional benchmarks were derived for these performance parameters, including 10th, 25th, 50th (median), 75th, and 90th percentile values. RESULTS: The study involved 332,926 diagnostic mammography examinations. Mean performance parameter values were abnormal interpretation rate, 8.0%; positive predictive value for abnormal interpretation, 31.4%; positive predictive value for biopsy recommended, 31.5%; positive predictive value for biopsy performed, 39.5%; cancer diagnosis rate, 25.3 per 1000 examinations; invasive cancer size, 20.2 mm; percentage of minimal cancers, 42.0%; percentage of axillary node-negative invasive cancers, 73.6%; and percentage of stage 0 and I cancers, 62.4%. CONCLUSION: The presented BCSC outcomes data and performance benchmarks may be used by mammography facilities and individual radiologists to evaluate their own performance for diagnostic mammography as determined by means of periodic comprehensive audits.     

Performance comparison of single-view digital breast tomosynthesis plus single-view digital mammography with two-view digital mammography

Objective

To determine the performance of combined single-view mediolateral oblique (MLO) digital breast tomosynthesis (DBT) plus single-view cranio-caudal (CC) mammography (MX) compared with that of standard two-view digital mammography.

Methods

A multi-reader multi-case (MRMC) receiver-operating characteristic (ROC) study was conducted, involving six breast radiologists. Two hundred fifty patients underwent bilateral MX and DBT imaging. MX and DBT images with the adjunct of the CC-MX view from 469 breasts were evaluated and rated independently by six readers. Differences in mean areas under the ROC curves (AUCs), mean sensitivity and mean specificity were analysed by analysis of variance (ANOVA) to assess clinical performance.

Results

The combined technique was found to be non-inferior to standard two-view mammography (MX_(CC+MLO)) in mean AUC (difference: +0.021;95 % LCL = ?0.011), but was not statistically significant for superiority (P?=?0.197). The combined technique had equivalent sensitivity to standard mammography (76.2 % vs. 72.8 %, P?=?0.269) and equivalent specificity (84.9 % vs. 83.0 %, P?=?0.130). Specificity for benign lesions was significantly higher with the combination of techniques versus mammography (45.6 % vs. 36.8 %, P?=?0.002).

Conclusion

In this enriched study population, the combination of single-view MLO tomosynthesis plus single-view CC mammography was non-inferior to that of standard two-view digital mammography in terms of ROC curve area, sensitivity and specificity.

Key Points

? Breast tomosynthesis (DBT) has emerged as a valuable adjunct to mammography (MX). ? Combination DBT/MX demonstrated non-inferior clinical performance to standard two-view MX. ? Combination DBT/MX was superior to two-view MX in recognising benign lesions. ? Combination DBT/MX reduced variability compared with two-view MX.     

Contribution of individual projections alone and in combination for radiographic detection of ankle fractures

OBJECTIVE: We wanted to determine whether the standard three-view ankle radiographic series could be replaced by a two-view combination, and if so, which two-view combination (anteroposterior with lateral or mortise with lateral) would be superior. MATERIALS AND METHODS: During a 12-month period, we retrospectively reviewed 556 consecutive ankle radiographic studies consisting of anteroposterior, mortise, and lateral views. One hundred twenty patients with at least one ankle fracture were paired with 140 healthy control subjects. Each image in the three-view examination was separated and sorted by view and studied independently; all images were reviewed by two skeletal radiologists and two orthopedic surgeons. Each radiograph was evaluated for fracture of the medial, lateral, and posterior malleoli and the foot using a five-point confidence rating. Performance of each view and modeled two- and three-view combinations of views was evaluated with modified receiver operating characteristic analysis. RESULTS: The data provide little support for preferring either two-view combination (anteroposterior-lateral or mortise-lateral) for any type of fracture. The three-view combination does detect significantly more fractures than some two-view combinations in some locations, and there is a statistically significant cost in diagnostic accuracy for eliminating the anteroposterior or mortise view. CONCLUSION: Reducing the ankle radiographic series from three to two views would result in a small but significant decrease in the detection of fractures of the ankle and foot. Both two-view combinations are equivalent for fracture detection.     

Digital breast tomosynthesis at screening assessment: are two views always necessary?

Objective:

The current recommendation from the UK National Health Service Breast Screening Programme is that digital breast tomosynthesis (DBT) can be used for further assessment of possible screen-detected soft-tissue abnormalities in place of spot compression views and when used should be performed in two projections. The aim of the study was to assess whether two-view DBT is necessary if the abnormality is seen only in one view on initial full-field digital mammography (FFDM).

Methods:

617 cases with possible masses, distortions and asymmetrical densities visualized only in one view on screening FFDM were included. All of these females underwent two-view DBT, clinical examination and ultrasound. The FFDM and DBT findings on each view were compared and correlated with the histological diagnosis.

Results:

586 of 617 cases had normal or benign findings on further assessment, and no additional information was obtained on the other DBT view. There were 31 confirmed cancers. In 26 cases (84%), the cancer was seen on the corresponding DBT view. No cancer was seen on the other DBT view alone. Five cancers (16%) were not seen on either view on DBT owing to technical reasons. No cancers would have been missed if only the corresponding DBT view was performed.

Conclusion:

Two-view DBT may not be necessary when used for further assessment of possible screen-detected soft-tissue abnormalities. Larger studies should be undertaken to investigate this further.

Advances in knowledge:

One-view DBT may be adequate in assessing soft-tissue abnormalities seen only on one FFDM view.     

Impact of Second-Opinion Interpretation of Breast Imaging Studies in Patients Not Currently Diagnosed With Breast Cancer

PurposeTo study the impact of second-opinion interpretation of breast imaging studies submitted from outside facilities to a tertiary cancer center.Materials and MethodsA retrospective database review was conducted of second-opinion interpretations rendered at our institution from January 1, 2010, to June 30, 2014, on studies from patients who did not have a concurrent breast cancer diagnosis. A total of 2,253 patients were included.ResultsIn 800 of 2,253 patients (35.5%), the BI-RADS categories assigned at our institution and at outside facilities were discordant. Of 973 patients assigned BI-RADS category 4 or 5 at outside facilities, 278 (28.6%) were assigned BI-RADS category 1 to 3 (no biopsy necessary) at our institution. Of 923 patients assigned BI-RADS category 1 to 3 at outside facilities, 191 (20.7%) were assigned BI-RADS category 4 or 5 at our institution, and 189 of these had biopsies, which revealed 23 cancers, 15 high-risk lesions, and 151 benign lesions. One high-risk lesion at core biopsy was upgraded to invasive ductal carcinoma and ductal carcinoma in situ (DCIS) on excision, resulting in 24 cancers. Of these, 18 reflected true additional breast cancers detected as a result of second-opinion interpretation: 12 invasive carcinomas and 6 cases of DCIS. These results translate into a 9.4% (18/191) positive predictive value for the number of cancers diagnosed among all biopsies recommended and a 9.5% (18/189) positive predictive value for the number of cancers diagnosed among all biopsies recommended and actually performed.ConclusionsThese findings demonstrate the positive clinical impact of second-opinion interpretation at a tertiary cancer center of outside-facility breast imaging studies in patients without a breast cancer diagnosis.     

The Impact of Patient-Initiated Subspecialty Review on Patient Care

PurposeTo determine the effect of subspecialty review of breast imaging on patients without a diagnosis of breast cancer who self-referred for a second opinion.MethodsInstitutional review board–approved retrospective review was performed of 415 breast imaging studies submitted to our cancer center for second-opinion review by 245 patients in 2014, excluding cases without follow-up or change in original BI-RADS 0 assessment. One hundred forty-seven patients with 176 lesions were included. Original and second-opinion interpretations and recommendations were compared with histopathology or follow-up imaging.ResultsNinety-six of 176 (55%) lesions were reported as suspicious in the original interpretation. Second-opinion review was discordant with the original interpretation in 82 of 176 (47%) lesions. Second-opinion review downgraded 24 of 96 (25%) lesions originally reported as suspicious to benign or probably benign, averting biopsy of these lesions. Second-opinion review upgraded 31 of 80 (39%) lesions originally reported as benign or probably benign to suspicious. A total of 87 lesions were biopsied yielding malignancy in 23 (26%) biopsies. Twenty-eight of 87 (32%) biopsies performed were recommended after second-opinion review, with 8 of 28 (29%) of these biopsies yielding cancer. Eight of 23 (35%) cancers detected represented malignancy not initially detected in the original interpretation.ConclusionSecond-opinion review is valuable in patients pursuing a breast imaging specialist’s opinion, even before they are diagnosed with breast cancer. Second-opinion review disagreed with the original interpretation for 47% of lesions, averted 25% of originally recommended biopsies, and detected cancer in 29% of additional biopsies recommended. Thirty-five percent of cancers diagnosed after second-opinion review were not initially detected in the original interpretation.     

Incident screening cancers detected with a second mammographic view: pathological and radiological features

Previous studies and epidemiological data from the UK National Health Service Breast Screening Programme (NHSBSP) have indicated significantly increased sensitivity for cancer detection with two-view rather than one-view mammographic screening. The radiological and pathological features of these extra cancers have not been previously reported in detail. We have studied all screen-detected cancers found as incident cases in the South West London Breast Screening Service between 1994-1997 on the second round of screening. To assess the effect of two-view versus one-view mammography on cancer detection, these cases were mixed with controls in a 1:2 ratio in nine test sets and each set read independently by three film readers. They initially read the oblique view, then the craniocaudal views, and recorded abnormalities on the films and likelihood of recall. Radiological and histological data were recorded for each case. Using two views, 8.9% (P < 0.05) more invasive cancers were detected. The sensitivity increase was highest for invasive cancers less than 10 mm (11%) and cancers of low grade (11.9%). These sensitivity increases may underestimate the increase in 'real life' because of over-recalling of normal mammograms, particularly with one view, under study conditions. The most significant radiological feature of invasive cancers was an irregular mass, which, seen on one view had a positive predictive value of 82.2% and 89.9% with two views. The craniocaudal view was helpful, firstly, because some cancers were not visible on the oblique view only. Secondly, benign appearing round masses and asymmetric densities seen with the oblique view only were resolved as more suspicious irregular masses with both views, leading to recall. In conclusion, there are cancers that cannot be adequately visualized on the oblique view alone. These are most commonly the small invasive cancers, which are of the greatest prognostic significance in breast cancer screening.     

Screening mammograms: interpretation with computer-aided detection--prospective evaluation

PURPOSE: To prospectively determine the effect of a commercially available computer-aided detection (CAD) system on interpretations of screening mammograms. MATERIALS AND METHODS: Institutional review board approval was granted; informed consent and HIPAA compliance were waived. A total of 21 349 screening mammograms obtained in 18 096 women were interpreted first without and then with review of CAD images to determine the effect of CAD analysis on the screening breast cancer detection rate, recall rate, and positive predictive value (PPV) for biopsy. The percentage of total cancers detected by the radiologists independent of CAD and the percentage correctly marked by the CAD system were determined. RESULTS: On the basis of pre-CAD interpretations, 2101 patients were recalled for diagnostic evaluation, 256 biopsies were performed, and 105 breast cancers were diagnosed. The breast cancer detection rate per 1000 screening mammograms was 4.92 (105 of 21 349 mammograms), the recall rate was 9.84% (2101 of 21 349 mammograms), and the PPV for biopsy was 41.0% (105 of 256 biopsies). After CAD image review, 199 additional patients were recalled, 21 additional biopsies were performed, and eight additional cancers were detected. The effect was a 7.62% (eight of 105) increase in the number of breast cancers detected, an increase in the recall rate to 10.77% (2300 of 21 349 mammograms), and a slight decrease in the PPV to 40.8% (113 of 277 biopsies). Radiologists detected 92.9% (105 of 113 cancers) of the total cancers, and CAD correctly marked 76.1% (86 of 113 cancers). CONCLUSION: The use of CAD improved the detection of breast cancer, with an acceptable increase in the recall rate and a minimal increase in the number of biopsies with benign results.     

Short interval follow-up after a benign concordant MR-guided vacuum assisted breast biopsy – is it worthwhile?

Objective

To determine the utility of short-interval follow-up after benign concordant MRI-guided breast biopsy.

Materials and methods

Institutional review board approved, retrospective review of consecutive biopsies performed over 3 years (2007–10) yielded 170 women with 188 lesions that were considered benign concordant. Indication for original study, biopsy results, follow-up recommendations, compliance and outcomes of subsequent MRI and mammography examinations were reviewed.

Results

The most common indication for breast MRI was high-risk screening 119/170 (70 %). Overall, 59 % of lesions (113/188) had follow-up MRI. Of those lesions (n?=?113), 43 % (49/113) presented within 7 months, 26 % (29/113) presented within 8–13 months, 11.5 % (13/113) presented within 14–22 months, and 19 % (22/113) presented after 23 months. At initial follow-up, 37 % of lesions were stable and 61 % were decreased in size. Three lesions were recommended for excision based on follow-up imaging with one malignancy diagnosed 2 years following biopsy. One additional patient had MRI-detected bilateral cancers remote from the biopsy site 3 years after biopsy.

Conclusion

Overall cancer yield of lesions with follow-up MRI was 0.9 % (1/113); no cancers were detected at 6 months. Our data suggests that 6-month follow-up may not be required and that annual screening MRI would be acceptable to maintain a reasonable cancer detection rate.

Key Points

? Follow-up recommendations after benign concordant MRI-guided breast biopsy remain controversial. ? Cancer detection rate was 0.9 % overall with no cancers detected at 6 months. ? Short-interval follow-up after benign concordant MRI-guided breast biopsy may not be necessary.     

Rate of compliance with recommendations for additional mammographic views and biopsies

All recommendations for immediate additional studies and biopsies following routine mammography during a 6-month period were reviewed retrospectively to establish compliance rates and determine the time intervals for completion of the recommendations. During this period, 5,693 mammograms were obtained. Additional mammographic studies and biopsies were recommended for 364 (6.4%) and 180 (3.2%) of all patients, respectively. The compliance rates were 99.7% (n = 363) for additional studies and 98.9% (n = 178) for biopsies. Additional studies and biopsies were completed within 30 days of the recommendations in 98.4% (n = 358) and 91.7% (n = 165) of the patients, respectively. Compliance with recommendations for additional studies within relatively short periods can be maximized by having the mammographic facility schedule examinations directly with the patients. Compliance with biopsy recommendations can be optimized by directly contacting the referring physician. Follow-up written reports should specifically state that a biopsy is recommended and that this has been discussed directly with the referring physician.     

Efficacy of spot compression-magnification and tangential views in mammographic evaluation of palpable breast masses.

To define the role of special mammographic views in evaluating palpable breast masses, 70 consecutive women with palpable breast masses underwent standard two-view examination of each breast and spot compression-magnification and tangential view examination of the palpable mass. Thirty palpable masses were found in 30 patients (43%). Standard views depicted 26 masses (87%). Tangential views also depicted 26 masses. Some of the masses seen on tangential views were not seen on standard views and vice versa. Spot compression-magnification views depicted 29 masses (97%). Special views thus depicted an additional 9% of palpable masses not seen on standard views (four of 44 cases). All lesions not seen on tangential views were central; the one lesion not seen on spot compression-magnification views was peripheral. Special views allowed correct prediction of benign or malignant status in 77% of cases (23 of 30), while standard views allowed correct prediction in 69% of cases (18 of 26).     

Clinical comparison of full-field digital mammography and screen-film mammography for detection of breast cancer

OBJECTIVE: The purpose of this work is to compare full-field digital mammography and screen-film mammography for the detection of breast cancer in a screening population. SUBJECTS AND METHODS: Full-field digital mammography was performed in addition to screen-film mammography in 6736 examinations of women 40 years old and older presenting for screening mammography at either of two institutions. Two views of each breast were acquired with each technique. The digital and screen-film mammograms were each interpreted independently. In addition to a clinical assessment, each finding was assigned a probability of malignancy for use in receiver operating characteristic analysis. In cases in which the digital and screen-film interpretations differed, a side-by-side analysis was performed to determine the reasons for the discrepancy. With few exceptions, findings detected on either technique were evaluated with additional imaging and, if warranted, biopsy. RESULTS: Additional evaluation was recommended on at least one technique in 1467 cases. These additional evaluations led to 181 biopsies and the detection of 42 cancers. Nine cancers were detected only on digital mammography, 15 were detected only on screen-film mammography, and 18 were detected on both. The difference in cancer detection is not statistically significant (p > 0.1). Digital mammography resulted in fewer recalls than did screenfilm mammography (799 vs 1007, p < 0.001). The difference between the receiver operating characteristic curve area for digital (0.74) and screen-film (0.80) mammography was not significant (p > 0.1). Reasons for discrepant interpretations of cancer were approximately equally distributed among those relating to lesion conspicuity, lesion appearance, and interpretation. CONCLUSION: No significant difference in cancer detection was observed between digital mammography and screen-film mammography. Digital mammography resulted in fewer recalls than did screen-film mammography.     

The effect of changing from one to two views at incident (subsequent) screens in the NHS breast screening programme in England: impact on cancer detection and recall rates

AIM: To assess the effect on cancer detection and recall rates of changing from one to two views for incident (subsequent) screens. METHODS: Controlled, comparative, observational study of programmes in NHS breast screening programme in England. Subjects: women aged 50-64 years were screened by the NHSBSP between 1 April 2001 and 31 March 2003. RESULTS: The effect of changing to two-view mammography was a 20% increase in overall incident screen cancer detection rate, with the biggest effect seen for small (<15 mm) invasive cancers. This increased detection rate was achieved with an 11% drop-in recall rate. CONCLUSION: The introduction of two-view mammography for incident screens has resulted in considerable improvements in overall NHS breast screening performance.     

An investigation into why two-view mammography is better than one-view in breast cancer screening

AIM: To determine why two-view mammography in screening for breast cancer is more effective than using a single medio-lateral oblique view.MATERIALS AND METHODS: In the United Kingdom Coordinating Committee on Cancer Research randomized trial of one- vs two-view mammography in breast cancer screening the oblique view was assessed by one radiologist and two views (oblique and cranio-caudal) assessed by another. For the present study the mammographic films were retrieved from the screening centres and assessed by three consultant radiologists. Mammographic films were available from 110 women; 87 had their breast cancer detected by both one and two views and in 23 it was missed by one view but detected using two views. Outcome measures were breast size, location and size of the cancer, mammographic features, presence of microcalcification and overall radiological assessment.RESULTS: Although 23 cancers were missed in the original trial when one view was used, only two were not visible on the oblique view. Cancers missed using a single oblique view (and only detected if the cranio-caudal view was available with the oblique) tended to be smaller by about 4 mm (P = 0.05), centrally located in the breast (P = 0.16), not spiculated or round, (P 相似文献   

Oblique radiographs of the chest in nonaccidental trauma

Purpose: Oblique radiographs of the chest were added to our skeletal survey for nonaccidental trauma to determine if these views improved our ability to diagnose rib fractures accurately. Methods: Seventy-three patients were evaluated with skeletal surveys for suspected child abuse. The chest films were reviewed independently by three radiologists as two separate sets, one with the frontal and lateral views only and one including the two oblique views. At the end of the study, consensus readings of all two- and four-view sets were reached and used as the true interpretations. Results: In 14 patients, positive rib fractures were identified by consensus. The accuracy, sensitivity, and specificity for each radiologist were greater with the four-view sets than with the two-view sets. In some children, rib fractures considered equivocal by two-view evaluation were called confidently as positive or negative with the additional views. Conclusion: The addition of oblique radiographs improves rib fracture evaluation in children suspected of having suffered nonaccidental trauma, increasing sensitivity, specificity, and accuracy as well as the radiologists' confidence.