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Breast imaging at Chris Hani Baragwanath Academic Hospital: A clinically relevant audit
Ilonka Warnich1, Ilana M Viljoen2, Marianne Kuehnast1
1Department of Radiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Insights
This breast imaging audit in South Africa revealed advanced breast cancer stages at presentation. Performing regular audits is crucial for improving interpretive performance and managing the disease burden.
Area of Science:
- Radiology
- Oncology
- Public Health
Background:
- Breast cancer poses a significant global health challenge.
- Chris Hani Baragwanath Academic Hospital (CHBAH) experiences a unique disease burden with late-stage breast cancer presentation.
Purpose of the Study:
- To conduct a breast-imaging audit at CHBAH.
- To evaluate interpretive performance and assess the stage of breast cancer at presentation.
Main Methods:
- Retrospective collection of demographic and imaging data over six months.
- Adherence to American College of Radiology-breast-imaging reporting and data system (ACR-BI-RADS) atlas (5th edn.) definitions.
- Comparison of performance metrics against Radiological Society of North America (RSNA) benchmarks.
Main Results:
- Analysis of 1549 mammography examinations.
- Screening subgroup: 13.6 cancers per 1000 studies (CDR), 5.94% recall rate.
- Diagnostic subgroup: 175.4 cancers per 100 studies (CDR), 39% abnormal interpretation rate (AIR).
- Significantly higher performance measures and advanced cancer characteristics (larger tumors, fewer minimal cancers, more nodal-negative cancers) compared to RSNA benchmarks (p < 0.0001).
Conclusions:
- The audit highlights challenges in South African breast imaging due to advanced loco-regional disease.
- Lack of national screening mammography contributes to the high cancer burden.
- Routine, clinically relevant audits are recommended for breast-imaging units.
Background:
Breast cancer is a major cause of morbidity and mortality worldwide. From experience, we have found that the disease burden at Chris Hani Baragwanath Academic Hospital (CHBAH) is unique with an advanced stage at presentation.
Objective:
To perform a breast-imaging audit at CHBAH, focused on interpretive performance and disease burden.
Method:
Demographic and imaging data were retrospectively collected over a 6-month period. Data collected and derived followed the audit-definitions and rules described within the American College of Radiology-breast-imaging reporting and data system (ACR-BI-RADS) atlas (5th edn.). A comparison was made to benchmark values published by the Radiological Society of North America (RSNA).
Results:
A total of 1549 mammography examinations were analysed. The screening subgroup (n = 808) revealed 11 cancers with a cancer detection rate (CDR) of 13.6 per 1000 studies and a recall rate of 5.94. The diagnostic subgroup (n = 741) revealed 130 cancers with a CDR of 175.4 and an abnormal interpretation rate (AIR) of 39 per 100 studies. Along with the positive predictive values, these performance measures for diagnostic mammography were significantly larger than the RSNA-benchmarks (p < 0.0001). In addition, the cancer characteristics showed a greater histological mean tumour length, a lower percentage of minimal cancers (defined as ductal carcinoma in situ [DCIS] and invasive cancers ≤ 1 cm) and fewer nodal-negative cancers (p < 0.0001), in keeping with a more advanced loco-regional stage at presentation.
Conclusion:
The study illustrates the challenges faced by a South African breast-imaging unit confronted with advanced loco-regional disease. The cancer burden is highlighted within a community where there is a lack of national screening mammography. The process of performing a basic, clinically relevant audit is simple and should be a routine practice in breast-imaging units.
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