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Ziel: Anhand ausgewahlter Qualitatsindikatoren aus der europaischen Leitlinie fur die Qualitatssicherung im Mammografiescreening und der Mammadiagnostik sowie der Stufe-3-Leitlinie (S3-Leitlinie) fur die Brustkrebsfruherkennung in Deutschland sollen die Struktur- und Prozessqualitat der qualitatsgesicherten Mammadiagnostik (QuaMaDi) im regionalen Vergleich und zeitlichen Verlauf beschrieben werden. Material und Methoden: Den Analysen liegen Routinedaten aus dem Versorgungsmodell QuaMaDi aus Schleswig-Holstein (SH) aus den Jahren 2006 – 2009 zugrunde. Die Berechnung von Qualitatsindikatoren (absolute, relative Haufigkeiten, 95 % Konfidenzintervalle) erfolgte gemas der o. g. Leitlinien. Ergebnisse: Jahrlich werden rund 6 % aller in SH lebenden Frauen ab 20 Jahren in QuaMaDi untersucht. Zwischen den vier Regionen unterscheiden sich die Patientinnenkollektive kaum (Altersverteilung, klinische und radiologische Befunde). Im Wesentlichen werden die Qualitatsindikatoren erfullt (z. B. Anteil mit mammografisch rontgendichter Brustdruse (ACR 3 oder 4) und erganzender Sonografie = 96,2 %; Anteil der Wiederholungsmammografien = 0,2 %). Zwischen den Regionen besteht nur eine leichte Varianz. Im zeitlichen Verlauf zeigt sich eine Annaherung an die Referenzwerte, sofern diese nicht schon zu Beginn erreicht wurden bzw. eine Konstanz der Qualitat. Schlussfolgerungen: Hinsichtlich der abbildbaren Qualitatsindikatoren werden die in den Leitlinien definierten Referenzwerte in neun von 12 Fallen erfullt. In einem Fall ist das Abweichen systemimmanent bedingt und in einem weiteren Fall betragt die Abweichung weniger als vier Prozentpunkte bei einem Zielwert von 90 %.

Nipple piercing gains popularity and social acceptance within the last years, especially among young people. The medical literature reports an increase of complications in the post-piercing period. We report a case of a young woman, who presented with a light enlargment of the right breast and tenderness in the retroareolar region following nipple piercing 5 months ago. On ultrasound, a poorly marginated hypoechoic lesion was seen which was suspicious of an inflammation. After 1 week of antibiotic therapy, the mass had enlarged. As carcinoma could not be excluded, open biopsy was performed. Histology showed signs of chronic mastitis. To date, only a few reports of breast abscess after nipple piercing have been published. With the increasing prevalence of body piercing, it is important to document and report infections which may be discovered many months following piercing. Carcinoma can mimick breast abscess and should be included in the differential diagnosis.

Our study addresses at the benefit of surveillance of probably benign lesions, detected outside mammographic screening, during a 3-year period. 28,588 women (mean age 57 ± 12 years) were examined. Two independent radiologists read the mammogram as well as the supplemented ultrasound (in case of breast density ACR type 3 and 4). In the case of discordance a third expert considered whether further examination was indicated or not. 3,266 diagnostic procedures ended with BI-RADS 3 result and 2,512 (76.9 %) women underwent a follow-up examination. 295 (11.7 %) of them received assessment examination (imaging and/or biopsy) and 37 (12.5 %) (none of them palpable) ended with BI-RADS 6. This equals a tumor detection rate of 14.7/1,000. The ratio in situ:invasive was 7:10 (1:1.43) and the mean size was 11.1 ± 4.51 mm. In the total cohort, 536 carcinomas ended with BI-RADS 6 of them 17 % were in situ and 83 % were invasive breast cancers (ratio in situ:invasive 1:4.99), mean size was 13.8 ± 6.3 mm. The cancer detection ratio in these cases was 18.7/1,000. The amount of detected tumors at follow-up of women with preceding BI-RADS 3 equates the associated potential of malignancy.

To address the benefits of double and arbitration reading regarding tumour detection rates, percentage of in situ tumours, and number (of patients) needed to send for expert reading (number needed to treat; NNT) for one additional tumour finding.QuaMaDi is a quality assured breast cancer diagnosis programme; with two-view mammography (craniocaudal, mediolateral oblique) and, in case of breast density ACR 3 or 4, routine ultrasound imaging; and with independent double reading of all images. A consecutive sample of symptomatic women, i.e. women at risk for breast cancer, women aged 70 and above, and/or women with preceding BI-RADS III findings, was analysed.28,558 mammograms were performed (mean age of women: 57.3 [standard deviation: 12.3] years). Discordant findings were present in 3,837 double readings and were sent for arbitration reading. After histopathological assessment, 52 carcinomas were found (thereof 32% in situ). These carcinomas accounted for 1.8 tumours per 1,000 examinations in the total cohort and increased the tumour detection rate up to 16.4/1,000. The NNT in discordant cases was 74.Double and arbitration reading appears to be a useful tool to ensure the quality of early detection of breast lesions in symptomatic women during indication-based, standardised mammography.• Quality assured breast cancer diagnosis is feasible outside organised screening structures. • Double and arbitration reading is beneficial for populations ineligible for screening. • Double and arbitration reading increases the tumour detection rate. • Double and arbitration reading increases the percentage of in situ cancers.