| Title | Variability in Interpretive Performance at Screening Mammography and Radiologists' Characteristics Associated with Accuracy. | | Author(s) | Elmore JG, Jackson SL, Abraham L, Miglioretti DL, Carney PA, Geller BM, Yankaskas BC, Kerlikowske K, Onega T, Rosenberg RD, Sickles EA, Buist DS | | Institution | Department of Medicine, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Ave, Box 359780, Seattle, WA 98104-2499, Department of Biostatistics, University of Washington School of Public Health, Seattle, Wash; Group Health Research Institute, Seattle, Wash; Department of Family Medicine, Oregon Health and Science University, Portland, Ore; Department of Family Medicine and Radiology, University of Vermont, Burlington, Vt; Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Departments of Medicine and Epidemiology and Biostatistics, and Radiology, University of California San Francisco, San Francisco, Calif; Department of Family Medicine, Dartmouth Medical School, Hanover, NH. | | Source | Radiology 2009 Oct 28. | | Abstract | Purpose: To identify radiologists' characteristics associated with interpretive performance in screening mammography. Materials and
Methods: The study was approved by institutional review boards of University of Washington (Seattle, Wash) and institutions at seven Breast Cancer Surveillance Consortium sites, informed consent was obtained, and procedures were HIPAA compliant. Radiologists who interpreted mammograms in seven U.S. regions completed a self-administered mailed survey; information on demographics, practice type, and experience in and perceptions of general radiology and breast imaging was collected. Survey data were linked to data on screening mammograms the radiologists interpreted between January 1, 1998, and December 31, 2005, and included patient risk factors, Breast Imaging Reporting and Data System assessment, and follow-up breast cancer data. The survey was returned by 71% (257 of 364) of radiologists; in 56% (205 of 364) of the eligible radiologists, complete data on screening mammograms during the study period were provided; these data were used in the final analysis. An evaluation of whether the radiologists' characteristics were associated with recall rate, false-positive rate, sensitivity, or positive predictive value of recall (PPV(1)) of the screening examinations was performed with logistic regression models that were adjusted for patients' characteristics and radiologist-specific random effects.
Results: Study radiologists interpreted 1 036 155 screening mammograms; 4961 breast cancers were detected. Median percentages and interquartile ranges, respectively, were as follows: recall rate, 9.3% and 6.3%-13.2%; false-positive rate, 8.9% and 5.9%-12.8%; sensitivity, 83.8% and 74.5%-92.3%; and PPV(1), 4.0% and 2.6%-5.9%. Wide variability in sensitivity was noted, even among radiologists with similar false-positive rates. In adjusted regression models, female radiologists or fellowship-trained radiologists had significantly higher recall and false-positive rates (P < .05, all). Fellowship training in breast imaging was the only characteristic significantly associated with improved sensitivity (odds ratio, 2.32; 95% confidence interval: 1.42, 3.80; P < .001) and the overall accuracy parameter (odds ratio, 1.61; 95% confidence interval: 1.05, 2.45; P = .028).
Conclusion: Fellowship training in breast imaging may lead to improved cancer detection, but it is associated with higher false-positive rates. (c) RSNA, 2009. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 19864507 |
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