Keywords:
Breast, Mammography, Screening, Quality assurance
Authors:
V. Kääb-Sanyal1, N. M. Perry2, M. Broeders3, M. Rosselli Del Turco4, M. A. O. Thijssen5, R. Holland3; 1Berlin/DE, 2London/UK, 3Nijmegen/NL, 4Roma/IT, 5Arnhem/NL
DOI:
10.26044/ecr2019/C-2079
Methods and materials
The EUREF Certification Protocols published in chapter 11 of the European Guidelines [1],
and more recently updated,
incorporate epidemiological,
radiological,
radiographical,
pathological,
and physico-technical performance evaluation.
The certification level suitable for the German RCs was that of European Reference Centre for Breast Screening.
Multidisciplinary visits by EUREF personnel to each RC commenced in 2007 with advisory visits,
followed by pre-certification visits in 2010.
The process included assessment of quality of screening and RC personnel,
adequacy of facilities,
resources,
and data collection as well as review of screening units’ performance parameters,
certification protocols and quality control.
Also,
reviews of imaging and interventional assessment techniques for screen-detected abnormalities,
pre-operative localisation techniques,
and individual cases of interval cancers (breast cancers diagnosed between two screening examinations) were carried out.
After every visit,
a detailed report with results and recommendations was issued.
Good response to the comments and advice based on the preparatory visits was observed.
The only long-lasting obstacle was the lack of ability in systematic,
complete recording and evaluating interval cancers.
Knowledge of the number and characteristics of interval cancers is indispensable for the proper epidemiological evaluation of a screening programme,
with individual case reviews being an essential part of the quality feed-back loop for radiologists.
To overcome this problem various laws and regulations have to be implemented in each federal state to allow the necessary data linkage between the results of the screening organisations and epidemiologic cancer registries.
Final certification visits were conducted in 2017.
At that time,
federal legislation only supported data linkage in the area of RC Munster and RC Nord.
Therefor only these RC were able to present consecutive series of interval cancers for review.
For the other three RCs,
Southwest,
Munich and Berlin,
it was agreed that series of screen detected T2+ cancers instead of interval cancers would be reviewed.
A key aim of the case reviews was to look at the review methods of the RCs and to ensure conformity with EUREF categorisation.
The RCs were asked to provide either consecutive or randomly selected series of cases already reviewed and categorised by the RC.
The review results of the EUREF team were then compared with those of the RC followed by discussion of any discordant results.