Effect of Order of Readings on Breast Cancer Detection Rate

When two readers interpret batches of mammography screenings, the order in which who performs the first reading and who does the follow-up interpretation makes no difference in rates of detection in breast cancer, according to a study published in JAMA.

Researchers from the United Kingdom performed a multicenter, double-blind, cluster randomized trial to determine if a vigilance decrement is present when two screeners consistently interpret the first or second reading of mammographic images.

A total of 360 readers participated in the trial: 186 radiologists, 143 radiography advanced practitioners, and 31 breast clinicians. All were divided into one of four groups. The intervention group comprised pairs of readers interpreting the images in opposite order – one forward and one in reverse or vice versa; the control group comprised pairs of readers who read consistently in the same order, both forward or both in reverse. A total of 1,194,147 women participated in the trial; 596,642 were in the intervention group and 597,505 in the control group. The images were interpreted in median batches of 35 images, and each reader interpreted a median of 176 batches.[[{"type":"media","view_mode":"media_crop","fid":"48928","attributes":{"alt":"Breast Screening","class":"media-image media-image-right","id":"media_crop_6920399043605","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5878","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 145px; width: 170px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©Sam72/Shutterstock.com","typeof":"foaf:Image"}}]]

The results showed that after completion of all subsequent diagnostic tests, a total of 10,484 cases (0.88%) of breast cancer were detected. The researchers noted no significant difference in the cancer detection rate with 5,272 cancers (0.88%) that were found in the intervention group, compared with the 5,212 (0.87%) in the control group.

“Interpretation of batches of mammograms by qualified screening mammography readers using a different order versus the same order for reading resulted in no significant difference in rates of detection of breast cancer,” the researchers concluded.