Real-time reading in mammography breast screening.

PURPOSE: 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. MATERIALS AND 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.