新冠疫后乳腺筛查异常者诊断评估及时性持续延迟
该单中心回顾性研究纳入2019年1月1日至2023年12月31日共15,814例BI-RADS 0筛查乳腺X线片，评估异常筛查后30/60/90天内诊断评估完成率。结果显示30天内完成率由2019年的88.8%持续降至2022年的55.4%，2023年回升至63.3%（p<0.001），60天与90天趋势相似；50-59岁、失业、单身、亚裔/太平洋岛民或黑人、社区剥夺指数最高五分位者90天内未随访风险更高。
要点
- BI-RADS 0后30天内诊断评估完成率由2019年88.8%降至2022年55.4%，2023年63.3%
- 60天与90天随访完成率呈相似下降趋势（p<0.001）
- 黑人、亚裔/太平洋岛民及高剥夺指数人群延迟随访风险更高，报告时可提示随访依从性风险
核心结论
- 新冠疫后数年乳腺筛查异常后的诊断评估延迟持续存在，且部分社会人口学亚组延迟随访风险更高。
研究设计与样本
- 单中心回顾性研究，纳入2019年1月1日至2023年12月31日筛查乳腺X线BI-RADS 0的15,814例，平均年龄55.5±12.0岁。
诊断标准与关键数值
- 异常筛查后30天内诊断评估完成率2019年88.8%、2022年55.4%、2023年63.3%（p<0.001），60天与90天趋势相似。
- 90天内未随访风险升高因素：50-59岁（RR 1.25）、失业（RR 1.18）、单身（RR 1.27）、亚裔/太平洋岛民（RR 1.37）、黑人（RR 1.69）、ADI最高五分位（RR 1.29）。
临床应用与阅片要点
- 阅片报告BI-RADS 0时应明确建议尽快完成诊断评估，并关注高风险亚组的随访落实。
- 可将随访及时性作为乳腺筛查质量指标之一进行监测。
局限性
- 单中心回顾性设计，结果外推需谨慎；未纳入影像征象分析。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
RATIONALE AND OBJECTIVES: To evaluate the timeliness of diagnostic evaluation after an abnormal screening mammogram in the years following the onset of the Coronavirus Disease 2019 (COVID-19) pandemic compared to the pre-pandemic year.
MATERIALS AND METHODS: We retrospectively identified all patients recalled from screening mammography at our institution from January 1, 2019, to December 31, 2023. We assessed the rate of diagnostic evaluation at 30, 60 and 90 days following abnormal screening. We also evaluated the association between follow-up timeliness and sociodemographic characteristics.
RESULTS: We identified a total of 15,814 screening mammograms with a BI-RADS 0 assessment during the study period. The mean age of the study cohort was 55.5 ± 12.0 years. The percentage of women who underwent diagnostic evaluation within 30 days of the abnormal screening mammogram persistently decreased from 88.8% in 2019 to 55.4% in 2022, then increased to 63.3% in 2023 (p < 0.001). Similar trends were observed in the rates of follow-up at 60 days and 90 days (p < 0.001). Age of 50-59 years (relative risk (RR): 1.25), being unemployed (RR: 1.18), single (RR: 1.27), of Asian/Pacific Islander (RR: 1.37) or Black race (RR: 1.69), or with neighborhood area deprivation index (ADI) in the highest quintile (RR=1.29) were significantly associated with higher risk of not following up within 90 days of an abnormal screening mammogram.
CONCLUSION: There have been persistent delays in diagnostic evaluation after an abnormal screening mammogram, with follow-up delays worsening during each year following the onset of the pandemic and certain subsets of women noted to be at higher risk for persistent, delayed follow-up. Evaluation of targeted interventions to provide support to subpopulations at higher risk for persistent, delayed follow-up may be beneficial.
引用
- Oluyemi ET, Carson KA, Ambinder EB, et al. Persistent Delays in Diagnostic Evaluation Timeliness After an Abnormal Screening Mammogram in the Years following the Onset of the COVID-19 Pandemic. Acad Radiol. 2026. PMID: 42000292. doi:10.1016/j.acra.2026.03.048
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。