Minority report - false negative breast assessment in women recalled for suspicious screening mammography: imaging and pathological features, and associated delay in diagnosis.

AIM: We studied imaging, pathology and diagnostic aspects of false negative assessment (FNA) in women recalled for suspicious screening mammography. METHOD: Subjects were women aged 50-69 years undergoing biennial screening mammography within the Florence District screening programme from January 1992-December 2001 (339,953 consecutive screens). We identified all cancers occurring in women recalled to assessment and ascertained, and reviewed, all cases considered as negative on assessment and subsequently diagnosed with breast cancer. We compared imaging features, tumour histology and stage, and diagnostic testing on assessment for all women with cancer, and presentation and length of delay in women falsely negative on assessment. RESULTS: Eleven thousand six hundred and twenty four women were recalled to diagnostic assessment (recall rate = 3.4%) predominantly for suspicious mammography (9,216 positive screens). Breast cancer was missed in 57 cases: a FNA rate of 0.50% (0.37-0.62%) and comprising 4.1% (3.0-5.1%) of cancers occurring in women recalled after a positive screen. Two types of abnormalities were significantly more frequent in FNA cases than cancers detected at assessment: mass with regular borders (21.1 vs. 5.6%, p = 10(-5)), and asymmetrical density (22.8 vs. 5.4%, p = 10(-5)). On review 56% of FNAs were benign or probably benign BI-RADS categories. FNA occurred in 1.4% of early recalls and in 0.4% of initial assessment (p=0.0001). Significantly fewer tests were performed when assessing missed cancers than detected cancers with the most significant difference noted for FNAC (29.8 vs. 96.0%, p=10(-6)); mammography as the only evaluation on assessment was more frequent in missed cancers (31.5% vs 0.2%, p = 10(-6)). The 57 missed cases were subsequently diagnosed at early recall (2 cases), next biennial screen (11 cases), or as interval breast cancers (44 cases) with a mean delay in diagnosis of 628 days. Tumour histology, size and nodal status did not significantly differ between cancers missed and cancers diagnosed on assessment. CONCLUSION: False negatives on assessment represent a minority group in whom screening has failed. They might be reduced by adopting a more intensive diagnostic approach to assessment. Although there was no evidence of a worse prognosis in cancers missed at assessment, the delay in diagnosis is substantial and may impact long-term outcomes.

Computer-aided detection (CAD) of cancers detected on double reading by one reader only.

We evaluated the role of computer-aided detection (CAD) in cancers undergoing double reading and detected by one reader only. A series of 33 cancers, originally missed by the first reader and detected by the second reader, and 75 negative controls were processed to assess CAD sensitivity, and was read by the six radiologists who originally missed the cancers with the help of CAD printouts. CAD case-based sensitivity, specificity and positive predictive value were 51.5%, 18.6% and 21.7%, respectively. Average sensitivity of all radiologists in all cancers in the series was 74.7%, being higher for CAD+ (86.2%) than for CAD- (62.5%) cancers (P<0.01). When reading cancer cases that they had originally missed, radiologists had a sensitivity of 75.8%, which was higher for CAD+ (100.0%) than for CAD- (58.3%) cancers. The average recall rate was 14.2%, the majority of recalls (45 out of 64) occurring for lesions marked by CAD. CAD may help in detecting at most half of cancers missed at a single reading but detected by a second reader.

[Difficult digestive hemorrhage: angiodysplasia]. / Emorragie digestive difficili: le angiodisplasie.

The authors report 7 cases of ileal and colonic angiodysplasia observed over a 3 year period (1992-1994). After a review of literature concerning etiology, pathology, diagnosis, and treatment emphasize the use of angiography for preoperatory diagnosis an intraoperatory localization of the lesion when this one is localized in the ileum. After review of usefull therapies, they stress the role of surgery as the most used therapy and only really complete.

[Colonic anastomoses. Methods compared]. / Le anastomosi coliche. Metodiche a confronto.

The authors used Bar-Valtrac for 18 months to perform colic anastomoses. To weigh up the effectiveness of this method they compare manual, Stapler and Bar-Valtrac anastomoses performed in this period. They examined 169 anastomoses in the same number of patients being careful of complications, post-operative canalizing, periods in hospital. It is clear that Bar-Valtrac is a good alternative to the stapler and to manual anastomoses because it is done in a way that doesn't determine anastomotic foreign body reactions and consequently reduces stenotic complications. The limit of this method is the great difficulty in performing low and very low colo-rectal anastomoses. Actually, to perform low and very low anastomoses, the authors prefer to use the Stapler that offers higher probabilities of recovery without complications and higher speed of carrying out.