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Hong S, Song SY, Park B, Suh M, Choi KS, Jung SE, Kim MJ, Lee EH, Lee CW, Jun JK. Effect of Digital Mammography for Breast Cancer Screening: A Comparative Study of More than 8 Million Korean Women. Radiology 2019; 294:247-255. [PMID: 31793847 DOI: 10.1148/radiol.2019190951] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Full-field digital mammography (FFDM) has been accepted as a superior modality for breast cancer screening compared with conventional screen-film mammography (SFM), especially in women younger than 50 years or with dense breasts. Purpose To evaluate the accuracy of FFDM for breast cancer screening. Materials and Methods Data from January 1, 2011 to December 31, 2013 in the database from a nationwide breast cancer screening program linked with the national cancer registry were retrospectively analyzed. The study included Korean women aged 40-79 years who had undergone screening mammography with SFM, computed radiography (CR), or FFDM. The sensitivity, specificity, positive predictive value (PPV), and absolute and relative differences among these modalities were calculated, followed by pairwise comparison tests with multiple testing corrections. The areas under the receiver operating characteristic curve (AUCs) were also estimated and compared by using the DeLong method with Bonferroni correction. Results Among the 8 482 803 women included (mean age, 55 years ± 10), 34.4% (2 920 279 of 8 482 803), 51.7% (4 385 807 of 8 482 803), and 13.9% (1 176 717 of 8 482 803) underwent SFM, CR, and FFDM, respectively. The sensitivity and PPV were higher for FFDM than for SFM (adjusted odds ratio, 1.77 [95% confidence interval {CI}: 1.62, 1.95] for sensitivity and 1.36 [95% CI: 1.29, 1.43] for PPV) and CR (adjusted odds ratio, 1.70 [95% CI: 1.56, 1.85] for sensitivity and 1.26 [95% CI: 1.20, 1.32] for PPV), whereas specificity was lower with FFDM. The overall AUC for FFDM was 0.80 (95% CI: 0.80, 0.81), which was higher than that for SFM (0.75 [95% CI: 0.75, 0.76]) and CR (0.76 [95% CI: 0.75, 0.76]). P < .05 was found for differences in sensitivity, PPV, and AUC among modalities overall and in most of the subgroups of age, breast density, and screening round. Conclusion Full-field digital mammography allows better discrimination or prediction of breast cancer in the general female population than screen-film mammography or computed radiography, regardless of age, breast density, or screening round. © RSNA, 2019 Online supplemental material is available for this article.
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Affiliation(s)
- Seri Hong
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Soo Yeon Song
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Boyoung Park
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Mina Suh
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Kui Son Choi
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Seung Eun Jung
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Min Jung Kim
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Eun Hye Lee
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Chan Wha Lee
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Jae Kwan Jun
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
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Choi JI, Jung SE, Kim PN, Cha SH, Jun JK, Lee HY, Park EC. Quality assurance in ultrasound screening for hepatocellular carcinoma using a standardized phantom and standard clinical images: a 3-year national investigation in Korea. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:985-995. [PMID: 24866605 DOI: 10.7863/ultra.33.6.985] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the quality of ultrasound (US) imaging for hepatocellular carcinoma screening. METHODS The investigation was performed at all medical institutes participating in the National Cancer Screening Program in Korea. For assessment of personnel, we inquired who was performing the US screenings. For phantom image evaluation, the dead zone, vertical and horizontal measurements, axial and lateral resolution, sensitivity, and gray scale/dynamic range were evaluated. For clinical image evaluation, US images of patients were evaluated in terms of the standard images, technical information, overall image quality, appropriateness of depth, foci, annotations, and the presence of any artifacts. RESULTS Failure rates for phantom and clinical image evaluations at general hospitals, smaller hospitals, and private clinics were 20.9%, 24.5%, 24.1% and 5.5%, and 14.8% and 9.5%, respectively. No statistically significant difference was observed in the failure rates for the phantom images among groups of different years of manufacture. For the clinical image evaluation, the results of radiologists were significantly better than those of other professional groups (P = .0001 and .0004 versus nonradiology physicians and nonphysicians, respectively). The failure rate was also higher when the storage format was analog versus digital (P < .001). CONCLUSIONS Approximately 20% of US scanners failed the phantom image evaluation. The year of scanner manufacture was not significantly associated with the results of the phantom image evaluation. The quality of the clinical images obtained by radiologists was the best.
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Affiliation(s)
- Joon-Il Choi
- Department of Radiology, Seoul St Mary's Hospital, School of Medicine, Catholic University of Korea, Seoul, Korea (J.-I.C., S.E.J.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (P.N.K.); Department of Radiology, Ansan Hospital, College of Medicine, Korea University, Ansan-si, Korea (S.H.C.); National Cancer Control Institute, National Cancer Center, Goyang-si, Korea (J.K.J.); Department of Social Medicine, College of Medicine, Dankook University, Cheonan-si, Korea (H.-Y.L.); and Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea (E.-C.P.)
| | - Seung Eun Jung
- Department of Radiology, Seoul St Mary's Hospital, School of Medicine, Catholic University of Korea, Seoul, Korea (J.-I.C., S.E.J.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (P.N.K.); Department of Radiology, Ansan Hospital, College of Medicine, Korea University, Ansan-si, Korea (S.H.C.); National Cancer Control Institute, National Cancer Center, Goyang-si, Korea (J.K.J.); Department of Social Medicine, College of Medicine, Dankook University, Cheonan-si, Korea (H.-Y.L.); and Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea (E.-C.P.).
| | - Pyo Nyun Kim
- Department of Radiology, Seoul St Mary's Hospital, School of Medicine, Catholic University of Korea, Seoul, Korea (J.-I.C., S.E.J.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (P.N.K.); Department of Radiology, Ansan Hospital, College of Medicine, Korea University, Ansan-si, Korea (S.H.C.); National Cancer Control Institute, National Cancer Center, Goyang-si, Korea (J.K.J.); Department of Social Medicine, College of Medicine, Dankook University, Cheonan-si, Korea (H.-Y.L.); and Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea (E.-C.P.)
| | - Sang Hoon Cha
- Department of Radiology, Seoul St Mary's Hospital, School of Medicine, Catholic University of Korea, Seoul, Korea (J.-I.C., S.E.J.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (P.N.K.); Department of Radiology, Ansan Hospital, College of Medicine, Korea University, Ansan-si, Korea (S.H.C.); National Cancer Control Institute, National Cancer Center, Goyang-si, Korea (J.K.J.); Department of Social Medicine, College of Medicine, Dankook University, Cheonan-si, Korea (H.-Y.L.); and Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea (E.-C.P.)
| | - Jae Kwan Jun
- Department of Radiology, Seoul St Mary's Hospital, School of Medicine, Catholic University of Korea, Seoul, Korea (J.-I.C., S.E.J.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (P.N.K.); Department of Radiology, Ansan Hospital, College of Medicine, Korea University, Ansan-si, Korea (S.H.C.); National Cancer Control Institute, National Cancer Center, Goyang-si, Korea (J.K.J.); Department of Social Medicine, College of Medicine, Dankook University, Cheonan-si, Korea (H.-Y.L.); and Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea (E.-C.P.)
| | - Hoo-Yeon Lee
- Department of Radiology, Seoul St Mary's Hospital, School of Medicine, Catholic University of Korea, Seoul, Korea (J.-I.C., S.E.J.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (P.N.K.); Department of Radiology, Ansan Hospital, College of Medicine, Korea University, Ansan-si, Korea (S.H.C.); National Cancer Control Institute, National Cancer Center, Goyang-si, Korea (J.K.J.); Department of Social Medicine, College of Medicine, Dankook University, Cheonan-si, Korea (H.-Y.L.); and Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea (E.-C.P.)
| | - Eun-Cheol Park
- Department of Radiology, Seoul St Mary's Hospital, School of Medicine, Catholic University of Korea, Seoul, Korea (J.-I.C., S.E.J.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (P.N.K.); Department of Radiology, Ansan Hospital, College of Medicine, Korea University, Ansan-si, Korea (S.H.C.); National Cancer Control Institute, National Cancer Center, Goyang-si, Korea (J.K.J.); Department of Social Medicine, College of Medicine, Dankook University, Cheonan-si, Korea (H.-Y.L.); and Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea (E.-C.P.)
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Lee S, Choi JI, Park MY, Yeo DM, Byun JY, Jung SE, Rha SE, Oh SN, Lee YJ. Intra- and interobserver reliability of gray scale/dynamic range evaluation of ultrasonography using a standardized phantom. Ultrasonography 2014; 33:91-7. [PMID: 24936501 PMCID: PMC4058983 DOI: 10.14366/usg.13021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 12/30/2013] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To evaluate intra- and interobserver reliability of the gray scale/dynamic range of the phantom image evaluation of ultrasonography using a standardized phantom, and to assess the effect of interactive education on the reliability. METHODS Three radiologists (a resident, and two board-certified radiologists with 2 and 7 years of experience in evaluating ultrasound phantom images) performed the gray scale/dynamic range test for an ultrasound machine using a standardized phantom. They scored the number of visible cylindrical structures of varying degrees of brightness and made a 'pass or fail' decision. First, they scored 49 phantom images twice from a 2010 survey with limited knowledge of phantom images. After this, the radiologists underwent two hours of interactive education for the phantom images and scored another 91 phantom images from a 2011 survey twice. Intra- and interobserver reliability before and after the interactive education session were analyzed using K analyses. RESULTS Before education, the K-value for intraobserver reliability for the radiologist with 7 years of experience, 2 years of experience, and the resident was 0.386, 0.469, and 0.465, respectively. After education, the K-values were improved (0.823, 0.611, and 0.711, respectively). For interobserver reliability, the K-value was also better after the education for the 3 participants (0.067, 0.002, and 0.547 before education; 0.635, 0.667, and 0.616 after education, respectively). CONCLUSION The intra- and interobserver reliability of the gray scale/dynamic range was fair to substantial. Interactive education can improve reliability. For more reliable results, double- checking of phantom images by multiple reviewers is recommended.
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Affiliation(s)
- Song Lee
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Joon-Il Choi
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Michael Yong Park
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Dong Myung Yeo
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jae Young Byun
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Seung Eun Jung
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sung Eun Rha
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Soon Nam Oh
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Young Joon Lee
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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