{Reference Type}: Journal Article
{Title}: Relative timing of mammography and MRI for breast cancer screening: Impact on performance evaluation.
{Author}: Lee JM;Ichikawa L;Kerlikowske K;Buist DSM;Lee CI;Sprague BL;Henderson LM;Onega T;Wernli KJ;Lowry KP;Stout NK;Tosteson ANA;Miglioretti DL;
{Journal}: J Am Coll Radiol
{Volume}: 0
{Issue}: 0
{Year}: 2024 Jul 3
{Factor}: 6.24
{DOI}: 10.1016/j.jacr.2024.06.020
{Abstract}: <B>OBJECTIVE: </B>Mammography and MRI screening typically occur in combination or in alternating sequence. We compared multimodality screening performance accounting for the relative timing of mammography and MRI and overlapping follow-up periods.<BR><B>METHODS: </B>We identified 8,260 screening mammograms performed 2005-2017 in the Breast Cancer Surveillance Consortium, paired with screening MRIs within +/- 90 days (combined screening) or 91-270 days (alternating screening). Performance for combined screening [cancer detection rate (CDR) per 1000 examinations and sensitivity] was calculated with one-year follow-up for each modality, and with a single follow-up period treating the two tests as a single test. Alternating screening performance was calculated with one-year follow-up for each modality and also with follow-up ending at the next screen if within one year (truncated follow-up).<BR><B>RESULTS: </B>For 3,810 combined screening pairs, CDR per 1000 screens was 6.8 (95%CI: 4.6-10.0) for mammography and 12.3 (95%CI: 9.3-16.4) for MRI as separate tests compared to 13.1 (95%CI: 10.0-17.3) as a single combined test. Sensitivity of each test was 48.1% (35.0%-61.5%) for mammography and 79.7% (95%CI: 67.7-88.0%) for MRI compared to 96.2% (95%CI: 85.9-99.0%) for combined screening. For 4,450 alternating screening pairs, mammography CDR per 1000 screens changed from 3.6 (95%CI: 2.2-5.9) to zero with truncated follow-up; sensitivity was incalculable (denominator=0). MRI CDR per 1000 screens changed from 12.1 (95%CI 9.3-15.8) to 11.7 (95%CI: 8.9-15.3) with truncated follow-up; sensitivity changed from 75.0% (95%CI 63.8-83.6%) to 86.7% (95%CI 75.5-93.2%).<BR><B>CONCLUSIONS: </B>Updating auditing approaches to account for combined and alternating screening sequencing and to address outcome attribution issues arising from overlapping follow-up periods can improve the accuracy of multimodality screening performance evaluation.