Radiographers supporting radiologists in the interpretation of screening mammography: a viable strategy to meet the shortage in the number of radiologists.

BACKGROUND: An alternative approach to the traditional model of radiologists interpreting screening mammography is necessary due to the shortage of radiologists to interpret screening mammograms in many countries. METHODS: We evaluated the performance of 15 Mexican radiographers, also known as radiologic technologists, in the interpretation of screening mammography after a 6 months training period in a screening setting. Fifteen radiographers received 6 months standardized training with radiologists in the interpretation of screening mammography using the Breast Imaging Reporting and Data System (BI-RADS) system. A challenging test set of 110 cases developed by the Breast Cancer Surveillance Consortium was used to evaluate their performance. We estimated sensitivity, specificity, false positive rates, likelihood ratio of a positive test (LR+) and the area under the subject-specific Receiver Operating Characteristic (ROC) curve (AUC) for diagnostic accuracy. A mathematical model simulating the consequences in costs and performance of two hypothetical scenarios compared to the status quo in which a radiologist reads all screening mammograms was also performed. RESULTS: Radiographer's sensitivity was comparable to the sensitivity scores achieved by U.S. radiologists who took the test but their false-positive rate was higher. Median sensitivity was 73.3 % (Interquartile range, IQR: 46.7-86.7 %) and the median false positive rate was 49.5 % (IQR: 34.7-57.9 %). The median LR+ was 1.4 (IQR: 1.3-1.7 %) and the median AUC was 0.6 (IQR: 0.6-0.7). A scenario in which a radiographer reads all mammograms first, and a radiologist reads only those that were difficult for the radiographer, was more cost-effective than a scenario in which either the radiographer or radiologist reads all mammograms. CONCLUSIONS: Given the comparable sensitivity achieved by Mexican radiographers and U.S. radiologists on a test set, screening mammography interpretation by radiographers appears to be a possible adjunct to radiologists in countries with shortages of radiologists. Further studies are required to assess the effectiveness of different training programs in order to obtain acceptable screening accuracy, as well as the best approaches for the use of non-physician readers to interpret screening mammography.

Utilidad clínica de la toma de biopsia fraccionada de endometrio por aspiración con jeringa y cánula de Kermann en el diagnóstico histopatológico de la paciente con sangrado postmenopáusico / Clinical utility of fractioned endometrial sampling by aspiration with Karmann syringe and cannula for histological diagnosis in patients who have post-menopausal bleeding

La toma de la biopsia fraccionada del endometrio por aspiración con cánula y jeringa de Karmann parece una buena opción, confiable y de bajo costo para el estudio de las pacientes con diagnóstico de sangrado postmenopausico en búsqueda de patología endometrial. Se estudiaron 68 pacientes de enero de 1997 a abril de 1998, previo interrogatorio y exploración física, se realizó ultrasonido transvaginal para la medición del grosor endometrial y posteriormente la toma de la biopsia de endometrio por aspiración con cánula y jeringa de karmann. El reporte histopatológico de las muestras endometriales obtenidas fue de 7 muestras con tejido insuficiente (10.3 por ciento), 35 con datos de atrofia (51.5 por ciento), 24 con hiperplasia endometrial simple sin atipias (35.3 por ciento) y 2 con cáncer endometrial (2.9 por ciento). El grosor endometrial medido por ultrasonido transvaginal en el estudio tuvo una media aritmética de 3.56 mm, con medida de 3.0 mm; 21 del total de pacientes fueron candidatas a tratamiento quirúrgico (histerectomía). Al final del estudio se reportó una sensibilidad 85.7 por ciento y una especificidad de 50 por ciento del método empleado. Los datos en relación con el grosor endometrial medido por ultrasonido transvaginal fueron que el grosor menor de 4 mm se asocia estadísticamente con atrofia a la vez que 5 mm o más se asocia con patología endometrial significativa (hiperplasia y cáncer)