Breast density assessment varies among radiologists

Sprangue et al published in Annals of Internal Medicine the findings of their study that suggests that radiologists often do not agree on what qualifies as dense breast.

The investigators looked at 216,783 mammograms from 145,123 women aged 40 to 89 years that were interpreted by 83 radiologists in 30 radiology facilities in 4 States.

Overall, 36.9% of mammograms were rated as showing dense breasts. Across radiologists, this percentage ranged from 6.3% to 84.5% (median, 38.7%). Examination of patient subgroups revealed that variation in density assessment across radiologists was pervasive in all but the most extreme patient age and BMI combinations. Among women who had consecutive mammograms interpreted by different radiologists, 17.2% (5909 of 34 271) of them suggested different density rating on the two tests.

The authors concluded because there is wide variation in density assessment across radiologists it is a fact should be carefully considered by providers and policymakers when considering supplemental screening strategies.

Colonoscopy vs. CT-Colonography for Detection of High-Risk Polyps

IJspeert et al published in the American Journal of Gastroenterology findings from a randomized trial in which computed tomography colonography (CTC) and colonoscopy were compared for the detection of high-risk sessile serrated polyps (SSP) in average-risk individuals.

Sessile serrated polyps (SSPs) are considered to be the precursors of 15–30% of all colorectal cancers (CRCs). Therefore, CRC screening modalities should be designed to detect high-risk SSPs.

The authors invited 8,844 individuals to join in the trial, of which 1,276 colonoscopy and 982 CTC invitees participated in the study. In the colonoscopy arm, 4.3% of individuals were diagnosed with ≥1 high-risk SSPs, compared with 0.8% in the CTC arm. In total, 3.1% of individuals in the colonoscopy arm were diagnosed with high-risk SSPs as most advanced lesion, compared with 0.4% in the CTC arm.  The current CTC strategy showed a marked lower detection for especially flat high-risk SSPs (17 vs. 0), high-risk SSP located in the proximal colon (32 vs. 1), and SSPs with dysplasia (30 vs. 1).

As sessile serrated polyps are considered precursors of colorectal cancers screening modalities should detect them with high rate of accuracy.  Findings from this trial suggest that the detection rate of high-risk SSPs was significantly higher with colonoscopy than computed tomographic colonography.