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Increase in Cancer Detection and Recall Rates with Independent Double Interpretation of Screening Mammography

Susan C. Harvey1, Berta Geller2, Robert G. Oppenheimer1, Melanie Pinet1, Leslie Riddell2 and Brian Garra1

1 Department of Radiology, Fletcher Allen Health Care, University of Vermont College of Medicine, UHC Campus, Burlington, VT 05401.
2 The Office of Health Promotion Research, University of Vermont, Burlington, VT 05401.



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  		Fig. 1A. —Asymptomatic 47-year-old woman. Mediolateral oblique (A) and craniocaudal (B) images from screening mammogram show cluster of pleomorphic calcifications in left breast (arrows) that were overlooked by first reviewer. Second reviewer recommended additional mammographic evaluation.

 


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  		Fig. 1B. —Asymptomatic 47-year-old woman. Mediolateral oblique (A) and craniocaudal (B) images from screening mammogram show cluster of pleomorphic calcifications in left breast (arrows) that were overlooked by first reviewer. Second reviewer recommended additional mammographic evaluation.

 


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  		Fig. 1C. —Asymptomatic 47-year-old woman. Spot compression magnification mediolateral (C) and craniocaudal (D) images show calcifications (arrows) in left breast in greater detail. In D, calcifications have linear distribution. Histologic analysis of excisional biopsy specimen revealed ductal carcinoma in situ associated with calcifications with no evidence of infiltrating carcinoma.

 


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  		Fig. 1D. —Asymptomatic 47-year-old woman. Spot compression magnification mediolateral (C) and craniocaudal (D) images show calcifications (arrows) in left breast in greater detail. In D, calcifications have linear distribution. Histologic analysis of excisional biopsy specimen revealed ductal carcinoma in situ associated with calcifications with no evidence of infiltrating carcinoma.

 


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  		Fig. 2A. —Asymptomatic 57-year-old woman. Mediolateral oblique (A) and craniocaudal (B) images from screening mammogram show subtle area of density in right central subareolar region (arrows) that was overlooked by first reviewer. Second reviewer recommended additional mammographic and sonographic evaluation.

 


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  		Fig. 2B. —Asymptomatic 57-year-old woman. Mediolateral oblique (A) and craniocaudal (B) images from screening mammogram show subtle area of density in right central subareolar region (arrows) that was overlooked by first reviewer. Second reviewer recommended additional mammographic and sonographic evaluation.

 


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  		Fig. 2C. —Asymptomatic 57-year-old woman. Spot compression magnification mediolateral (C) and craniocaudal (D) images show dense tissue without focal defined mass in right central subareolar region.

 


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  		Fig. 2D. —Asymptomatic 57-year-old woman. Spot compression magnification mediolateral (C) and craniocaudal (D) images show dense tissue without focal defined mass in right central subareolar region.

 


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  		Fig. 2E. —Asymptomatic 57-year-old woman. Sonogram shows 0.7-cm hypoechoic solid mass in right breast at 12:30-o'clock position 3 cm from nipple (arrows) in region of density seen on screening mammogram. Analysis of sonographically guided 14-gauge automated large core biopsy specimen revealed infiltrating ductal carcinoma. At mastectomy, 4.0-cm infiltrating ductal carcinoma was found. In addition, axillary nodes were found to be positive for metastatic disease.

 

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