RELIABILITY OF MULTIMODAL EVALUATION OF ABNORMAL SCREENING MAMMOGRAM RESULTS

OBJECTIVE: Our purpose was to evaluate the effectiveness and reliabili ty of the multimodal evaluation of suspicious or equivocal screening m ammogram results by use of ancillary imaging studies and needle biopsi es. STUDY DESIGN: This article reports on the experience of the Breast Evaluation Center at Long Beach Memorial Medical Center between 1989 and 1993 where 43,125 screening mammograms were performed. RESULTS: A total of 2866 patients were called back for additional evaluation, whi ch consisted of magnification views and ultrasonography. Since 1990 fi ne-needle biopsies have been done on selected patients and since 1992 core biopsies have been available. Needle localization excisional biop sies were performed on 344 patients, and 158 cancers were diagnosed. T his represents a 46% positive predictive value. Careful follow-up was obtained on the patients seen in 1990 to attempt to determine whether any cancers developed within a year of the time the patients with abno rmal screening mammogram results had been evaluated with imaging modal ities but no tissue diagnosis made. One cancer may have been missed. T he cost savings of this protocol are also examined. CONCLUSION: Multim odal evaluation of patients with suspicious screening mammogram result s appears to be a cost effective approach with adequate sensitivity an d specificity.