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False negative assessments: an effective quality assurance method

Objective

To identify the frequency and characteristics of false negative assessment (FNA); an interval cancer with prior recall to assessment.

Methods

A retrospective audit, over 7 years, between 1 April 2004 and 31 March 2011. Using NBSS databases, we recorded: lesion type, size, further mammographic views, ultrasound, clinical findings, biopsy results and final histology.

Results

Twenty-nine cases by QARC, 13 true FNA and 16 excluded because contralateral or in a different quadrant. In this period, 220,522 woman were screened and 10,391 (<5%) were referred for assessment. Total cancers detected in this period were 2,343, of which 1,867 were diagnosed at assessment and 476 (20%) were interval cancers. True FNA: 2.7% of all interval cancers. True FNA: 0.6% of all screen-detected cancers. All cases were background mixed density. True FNA: 11/13 incident screen, 2/13 prevalent. Asymmetry/stromal deformity in 7/13 (54%), calcification 4/13 (30%), mass 2/13 (15%). Two cases were early recall (EC) (asymmetry, and mass with calcifications), both incident screens. EC did not contribute in either case as it led to false reassurance. All asymmetry/stromal deformity reassuring on further views, with no correlating ultrasound or clinical abnormality. On review of all cases, only 2/13 were felt not to have had complete triple assessment. Final pathology: two DCIS, four lobular cancers, seven ductal cancers. Seven cases were discussed at a multidisciplinary meeting.

Conclusion

True FNA remains very low. This is because assessment cases have complete triple assessment and MDT discussion. FNA can be used as a valuable educational process and mechanism to ensure consistency and adherence to NHSBSP standards.

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Correspondence to DD Manuel.

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Manuel, D., Dall, B. & Sharma, N. False negative assessments: an effective quality assurance method. Breast Cancer Res 14, P45 (2012). https://doi.org/10.1186/bcr3300

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Keywords

  • Ductal Cancer
  • Interval Cancer
  • Multidisciplinary Meeting
  • Final Histology
  • Lobular Cancer