Performance of diagnostic centers in the classification of opportunistic screening mammograms from the Brazilian public health system (SUS)

Rodrigues, Danielle Cristina Netto; Freitas-Junior, Ruffo; Corrêa, Rosangela da Silveira; Peixoto, João Emílio; Tomazelli, Jeane Gláucia; Rahal, Rosemar Macedo Sousa

doi:10.1590/S0100-39842013000300008

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Sumário

Original Articles • Radiol. Bras. 46 (3) • May-Jun 2013 • https://doi.org/10.1590/S0100-39842013000300008 copy

Performance of diagnostic centers in the classification of opportunistic screening mammograms from the Brazilian public health system (SUS)^* * Study developed by the Program of Mastology, Hospital das Clínicas da Universidade Federal de Goiás (UFG) – Rede Goiana de Pesquisa em Mastologia, Goiânia, GO, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective

To evaluate the performance of diagnostic centers in the classification of mammography reports from an opportunistic screening undertaken by the Brazilian public health system (SUS) in the municipality of Goiânia, GO, Brazil in 2010.

Materials and Methods

The present ecological study analyzed data reported to the Sistema de Informação do Controle do Câncer de Mama (SISMAMA) (Breast Cancer Management Information System) by diagnostic centers involved in the mammographic screening developed by the SUS. Based on the frequency of mammograms per BI-RADS^® category and on the limits established for the present study, the authors have calculated the rate of conformity for each diagnostic center. Diagnostic centers with equal rates of conformity were considered as having equal performance.

Results

Fifteen diagnostic centers performed mammographic studies for SUS and reported 31,198 screening mammograms. The performance of the diagnostic centers concerning BI-RADS classification has demonstrated that none of them was in conformity for all categories, one center presented conformity in five categories, two centers, in four categories, three centers, in three categories, two centers, in two categories, four centers, in one category, and three centers with no conformity.

Conclusion

The results of the present study demonstrate unevenness in the diagnostic centers performance in the classification of mammograms reported to SISMAMA from the opportunistic screening undertaken by SUS.

Breast cancer; Screening programs; Mammography; Information systems; Health services

BI-RADS category	Diagnostic conclusion	Recommended management strategy
0	Further assessment with ultrasonography	Supplementary ultrasonography
1	No mammographic finding	Routine screening in one year
2	Benign mammographic findings	Routine screening in one year
3	Probably benign mammographic findings	Radiological follow-up in six months
4	Suspicious mammographic findings	Histopathology
5	Highly suspicious mammographic findings	Histopathology
6	Mammographic findings and biopsy with diagnosis of cancer	Specific therapy

Clinical indication	SUS network (n = 8,268)		Private network (n = 23,186)		p-value^* * Test: Proportion difference.
Clinical indication	n	%	n	%	p-value^* * Test: Proportion difference.
Diagnosis	27	0.3	229	1.0	0.395
Screening	8,241	99.7	22,957	99.0	0.999

BI-RADS category	SUS network (n = 8,239)^* * Test: Proportion difference.		Private network (n = 22,957)
BI-RADS category	%	(min – max)	%	(min – max)
0	11.3	(7.8 – 14.8)	9.1	(0.0 – 22.6)
1	51.9	(42.9 – 61.0)	67.9	(14.4 – 100.0)
2	41.6	(36.8 – 46.4)	29.5	(0.0 – 84.2)
3	2.8	(0.7 – 4.9)	1.9	(0.0 – 5.8)
4	3.5	(1.4 – 5.6)	0.6	(0.0 – 1.5)
5	0.2	(0.1 – 0.3)	0.1	(0.0 – 1.3)

BI-RADS category	Number of mammograms per category	Percentage per BI-RADS category	Minimum threshold^† † The thresholds were established with basis on the percentage of mammograms per BI-RADS category, with a variation of ± 30%.	Maximum threshold^† † The thresholds were established with basis on the percentage of mammograms per BI-RADS category, with a variation of ± 30%.
0	3,122	10.01	7.01	13.01
1	17,410	55.81	39.07	72.55
2	92,494	30.43	21.30	39.56
3	761	2.44	1.71	3.17
4	376	1.21	0.84	1.57
5	33	0.11	0.07	0.14
Total	31,196^* * Teste: Diferença de proporção.	—	—	—

Diagnostic center	Number of mammograms (31.196)	Percentage of mammograms per diagnostic conclusion						Rate of compliance
Diagnostic center	Number of mammograms (31.196)	BI-RADS 0	BI-RADS 1	BI-RADS 2	BI-RADS 3	BI-RADS 4	BI-RADS 5	Rate of compliance
1^* * Test: Proportion difference.	2,871	9.68	55.66	30.58	3.76	0.24	0.07	66.67
2^* * Test: Proportion difference.	474	—	100.00	—	—	—	—	—
3^* * Test: Proportion difference.	731	1.50	94.25	3.83	0.14	0.27	—	—
4^* * Test: Proportion difference.	3,378	17.41	36.23	40.32	4.77	1.18	0.09	50.00
5^* * Test: Proportion difference.	4,084	11.95	59.70	23.04	4.43	0.73	0.15	50.00
6^* * Test: Proportion difference.	3,318	1.42	71.64	25.14	1.78	0.03	—	50.00
7^* * Test: Proportion difference.	1,223	8.83	48.08	38.51	3.03	1.31	0.25	83.33
8^* * Test: Proportion difference.	1,139	7.37	13.35	77.96	0.70	0.44	0.18	16.67
9^* * Test: Proportion difference.	1,031	5.63	88.75	5.33	—	0.29	—	—
10^* * Test: Proportion difference.	2,165	8.59	74.97	14.97	0.09	1.34	0.05	33.33
11^* * Test: Proportion difference.	1,271	9.83	63.81	25.89	0.31	0.16	—	33.33
12^† † Os limites foram estabelecidos a partir do percentual de exames por categoria BI-RADS, com uma variação de ± 30%.	4,611	7.76	56.28	33.92	0.63	1.30	0.11	66.67
13^* * Test: Proportion difference.	888	22.64	38.96	35.47	2.36	0.56	—	16.67
14^* * Test: Proportion difference.	384	13.80	66.41	18.75	—	0.78	0.26	16.67
15^† † Os limites foram estabelecidos a partir do percentual de exames por categoria BI-RADS, com uma variação de ± 30%.	3,628	14.80	36.52	39.50	4.13	4.77	0.28	16.67
Number of compliances	—	7	7	6	3	4	2	—

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[1] Mailing Address: Danielle Cristina Netto Rodrigues. Programa de Mastologia, Hospital das Clínicas da UFG. 1^a Avenida, s/n°, Setor Universitário. Goiânia, GO, Brazil, 74605-050. E-mail: daniellepsinetto@yahoo.com.br.